Organization
DR MARILYN D JACKSON & ASSOCIATES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN DENISE JACKSON DDS (DENTIST PRESIDENT OF CORPORATION)
(708) 757-3100
Entity
Organization
Contact information
Practice address
1705 E SAUK TRL, SAUK VILLAGE, IL 60411-4955
(708) 757-3100
(708) 757-3272
Mailing address
PO BOX 1893, CHICAGO HEIGHTS, IL 60412-1893
(708) 757-3100
(708) 757-3272
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
01917207
IL
122300000X
Dentist
12009402
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002324
—
IL
Enumeration date
12/06/2005
Last updated
08/22/2020
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