Individual
DR. LUE DEE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
386 A-B WARREN STREET, ROXBURY, MA 02119
(800) 676-2750
Mailing address
18 CLAREMONT PARK, BOSTON, MA 02118-3002
(800) 676-2750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15374
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0262331
—
MA
Enumeration date
06/19/2008
Last updated
06/19/2008
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