Individual
MARVIN BLANE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4550 E BELL RD. ST. 102, PHOENIX, AZ 85032-9306
(602) 485-1588
(602) 707-9740
Mailing address
230 N FAIRGROUNDS RD, PRICE, UT 84501-4205
(435) 637-2100
(435) 637-5007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6605138-9921
UT
122300000X
Dentist
Primary
D010196
AZ
Other
Enumeration date
08/13/2007
Last updated
10/06/2021
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