Organization
DR RICHARD K JACKSON PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD K JACKSON DDS (DENTIST)
(561) 737-6445
Entity
Organization
Contact information
Practice address
326 W BOYNTON BEACH BLVD, BOYNTON BEACH, FL 33435-4025
(561) 737-6445
(561) 737-1524
Mailing address
326 W BOYNTON BEACH BLVD, BOYNTON BEACH, FL 33435-4025
(561) 737-6445
(561) 737-1524
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN12332
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073772100
—
FL
Enumeration date
01/19/2012
Last updated
01/19/2012
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