Organization
CENTERILLE PEDIATRIC DENTISTRY, KYLE R JACKSON, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE R. JACKSON DDS (DENTIST/OWNER)
(937) 586-7729
Entity
Organization
Contact information
Practice address
273 REGENCY RIDGE DR, CENTERVILLE, OH 45459-4221
(937) 586-7729
(937) 660-4450
Mailing address
273 REGENCY RIDGE DR, CENTERVILLE, OH 45459-4221
(937) 586-7729
(937) 660-4450
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30018976
OH
Other
Enumeration date
11/02/2013
Last updated
08/11/2016
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