Individual
DR. T. RYAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
45 N. MADISON AVE., GREENWOOD, IN 46142
(317) 887-3180
(317) 882-2718
Mailing address
45 N. MADISON AVE., GREENWOOD, IN 46142
(317) 887-3180
(317) 882-2718
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
12009768
IN
Other
Enumeration date
10/04/2006
Last updated
07/25/2011
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