Individual
DR. LARRY TYLER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
14100 N 83RD AVE, STE 280, PEORIA, AZ 85381-5658
(623) 935-9873
Mailing address
14100 N 83RD AVE, STE 280, PEORIA, AZ 85381-5658
(623) 935-9873
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D009113
AZ
Other
Enumeration date
07/08/2013
Last updated
04/07/2017
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