Individual
JACKSON LAWLER ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6459 OMAHA BLVD, COLORADO SPRINGS, CO 80915-2618
(719) 597-9057
(719) 597-2189
Mailing address
6459 OMAHA BLVD, COLORADO SPRINGS, CO 80915-2618
(719) 597-9057
(719) 597-2189
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104589
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010274
NATIONAL PAYOR ID
CO
Enumeration date
05/22/2007
Last updated
07/08/2007
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