Individual
LOUIS JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8201 GOLF COURSE RD NW, ALBUQUERQUE, NM 87120-5842
(505) 892-9010
Mailing address
888 BRIGHTON AVE, PORTLAND, ME 04102-1004
(207) 772-4111
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DEN4862
ME
Other
Enumeration date
07/09/2014
Last updated
08/15/2024
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