Individual
MICHAEL ALAN JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS ,MS
Contact information
Practice address
822 PORTAGE TRAIL, CUYAHOGA FALLS, OH 44221
(330) 929-2853
(330) 929-3821
Mailing address
610 FIXLER DRIVE, WADSWORTH, OH 44281
(330) 334-1967
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
17357
OH
Other
Enumeration date
10/23/2006
Last updated
07/08/2007
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