Organization
NEALL JACKSON DDS PA
Active
Other names
Puryear Jackson Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY DIANE CATHEY (OFFICE MANAGER)
(870) 238-3628
Entity
Organization
Contact information
Practice address
715 ELDRIDGE AVE E, WYNNE, AR 72396-4032
(870) 238-3628
(870) 238-0757
Mailing address
P.O. BOX 368, 715 EAST ELDRIDGE AVENUE, WYNNE, AR 72396
(870) 238-3628
(870) 238-0757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3520
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159065608
—
AR
Enumeration date
09/30/2009
Last updated
09/30/2009
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