Individual
DR. HARRY KEITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
116 HILLS PLZ, CHARLESTON, WV 25387-2438
(304) 720-4466
(304) 720-4813
Mailing address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 720-4466
(304) 720-4813
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2140
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135354000
—
WV
05
—
1336234640
—
WV
Enumeration date
10/03/2006
Last updated
08/02/2019
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