Organization
THE PRACTICE OF ANESTHESIA & GEN. DENTISTRY
Active
Parent organization
LUE DEE JACKSON JR. DMD, MD DBA THE PRACTICE OF ANESTH. & GEN. DENT.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LUE DEE JACKSON JR. DMD, MD DBA THE PRACTICE OF ANESTH. & GEN. DENT.
Authorized official
LUE DEE JACKSON JR. DMD, MD (GEN. DENTIST & ANESTHESIOLOGIST/OWN)
(800) 676-2750
Entity
Organization
Contact information
Practice address
386 A/B WARREN STREET, ROXBURY, MA 02119-0000
(800) 676-2750
Mailing address
18 CLAREMONT PARK, BOSTON, MA 02118-3002
(800) 676-2750
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
15374
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0262331
—
MA
Enumeration date
03/24/2008
Last updated
03/24/2008
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