Organization
JACKSON SLEEP CENTERS PLLC
Active
Other names
Koala Center for Sleep & TMJ Disorders MI-1
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT JACKSON DDS (OWNER)
(810) 664-4641
Entity
Organization
Contact information
Practice address
11825 STATE ROUTE 40, SUITE 100, DUNLAP, IL 61525-8842
(309) 839-9971
(309) 807-3365
Mailing address
454 S MAIN ST, LAPEER, MI 48446-2427
(810) 664-4641
(810) 272-4293
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901009946
MI
122300000X
Dentist
Primary
2901021258
MI
Other
Enumeration date
04/27/2016
Last updated
04/27/2016
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