Individual
DR. BASIL JACKSON FRIEND II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
15806 JEFFERSON DAVIS HWY, COLONIAL HEIGHTS, VA 23834-5202
(804) 520-8994
Mailing address
15806 JEFFERSON DAVIS HWY, COLONIAL HEIGHTS, VA 23834-5202
(804) 520-8994
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007135
VA
Other
Enumeration date
06/23/2011
Last updated
06/23/2011
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