Organization
DARRELL JACKSON
Active
Other names
Cottonwood Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARRELL GILBERT JACKSON D.D.S. (OWNER)
(719) 589-5272
Entity
Organization
Contact information
Practice address
2405 MULLINS AVE, ALAMOSA, CO 81101
(719) 589-5272
(719) 589-5300
Mailing address
2405 MULLINS AVE, ALAMOSA, CO 81101
(719) 589-5272
(719) 589-5300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8293
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08230064
—
CO
Enumeration date
08/24/2005
Last updated
08/19/2008
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