Individual
ELBERT E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 GLEAVES ST, SUITE C, MADISON, TN 37115-2154
(615) 859-1881
(615) 865-7723
Mailing address
200 GLEAVES ST, SUITE C, MADISON, TN 37115-2154
(615) 859-1881
(615) 865-7723
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS2474
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
557446
UCCI
TN
Enumeration date
12/01/2006
Last updated
07/08/2007
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