Individual
SARAH BETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 851-1551
(314) 865-3479
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2020024844
MO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/08/2020
Last updated
04/13/2021
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