Organization
LEROY R JACKSON JR DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN ROSSBERG (OWNER)
(904) 725-6634
Entity
Organization
Contact information
Practice address
215 E 5TH AVE, RANSON, WV 25438-1613
(304) 725-8660
(304) 728-7519
Mailing address
215 E 5TH AVE, RANSON, WV 25438-1613
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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