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Organization

ELI JACKSON III PSC

Active
Other names
CHANDLER PARK DENTAL CARE
Organization subpart
No

Provider details

NPI number
Authorized official
ELI O JACKSON III DMD (OWNER)
(270) 781-2952
Entity
Organization

Contact information

Practice address
1857 TUCKER WAY, BOWLING GREEN, KY 42104-6258
(270) 781-2952
(270) 793-0977
Mailing address
1857 TUCKER WAY, BOWLING GREEN, KY 42104-6258
(270) 781-2952
(270) 793-0977

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5450
KY

Other

Enumeration date
05/14/2015
Last updated
09/14/2016
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