Individual
DR. THOMAS MATTHEW JACKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2650 SUZANNE WAY STE 110, EUGENE, OR 97408-7619
(541) 726-4690
Mailing address
34362 DEERWOOD DR, EUGENE, OR 97405-9662
(301) 943-0945
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D10665
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
823753470
TAX ID
OR
Enumeration date
01/20/2006
Last updated
02/15/2018
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