Individual
DR. WILLIAM TRAVIS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
402 E WALNUT ST, NEVADA, MO 64772-2458
(417) 667-3006
Mailing address
402 E WALNUT ST, NEVADA, MO 64772-2458
(417) 667-3006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2008015522
MO
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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