Individual
DR. ZACHARY JACOB JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7223 MISSISSIPPI AVE, FORT POLK, LA 71459-0001
(726) 780-1451
Mailing address
7223 MISSISSIPPI AVE, FORT POLK, LA 71459-0001
(726) 780-1451
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11316
OR
1223E0200X
Endodontics
192325
AK
1223E0200X
Endodontics
Primary
7727
LA
1223G0001X
General Practice Dentistry
192325
AK
Other
Enumeration date
09/01/2020
Last updated
08/04/2025
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