Individual
COURTNEY MOORE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
10401 W LINCOLN AVE STE 210, MILWAUKEE, WI 53227-1255
(414) 546-1900
Mailing address
10401 W LINCOLN AVE STE 210, MILWAUKEE, WI 53227-1255
(414) 546-1900
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
600142815
WI
Other
Enumeration date
07/19/2015
Last updated
08/07/2024
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