Organization
STEVEN C. JACKS, D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN C. JACKS D.D.S. (PRESIDENT)
(937) 277-8959
Entity
Organization
Contact information
Practice address
7111 N MAIN ST, DAYTON, OH 45415-2565
(937) 277-8959
(937) 277-6161
Mailing address
7111 N MAIN ST, DAYTON, OH 45415-2565
(937) 277-8959
(937) 277-6161
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
19745
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005092
—
OH
Enumeration date
08/27/2007
Last updated
06/13/2013
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