Individual
JACKSON CANTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 WASHINGTON ST, BEARDSTOWN, IL 62618-1558
(217) 323-2701
Mailing address
507 WASHINGTON ST, BEARDSTOWN, IL 62618-1558
(217) 323-2701
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019032733
IL
Other
Enumeration date
07/06/2020
Last updated
07/06/2020
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