Individual
KEVIN R JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4150 MACLAND RD, SUITE 205, POWDER SPRINGS, GA 30127-1202
(770) 222-1344
(770) 222-1345
Mailing address
5605 MAXON MARSH DR, HIRAM, GA 30141-2880
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012902
GA
Other
Enumeration date
02/01/2007
Last updated
07/10/2007
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