Individual
MR. MARK K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7007 OLD SAUK ROAD, MADISON, WI 53717
(608) 833-2060
(608) 833-1737
Mailing address
3556 TIMBER LANE, CROSS PLAINS, WI 53528
(608) 798-3733
(608) 833-1737
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3459
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33475100
—
WI
Enumeration date
07/26/2006
Last updated
07/08/2007
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