Organization
GROVE CREEK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN D JACKSON DDS (DENTIST)
(801) 796-7779
Entity
Organization
Contact information
Practice address
238 E STATE RD STE 2, PLEASANT GROVE, UT 84062-3621
(801) 796-7779
(801) 796-5510
Mailing address
238 E STATE RD STE 2, PLEASANT GROVE, UT 84062-3621
(801) 796-7779
(801) 796-5510
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7025515
UT
Other
Enumeration date
01/25/2018
Last updated
01/25/2018
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