Individual
PATRICK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16 WASHINGTON ST, TOMS RIVER, NJ 08753-7643
(732) 914-1171
(732) 914-8472
Mailing address
16 WASHINGTON ST, TOMS RIVER, NJ 08753-7643
(732) 914-1171
(732) 914-8472
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01880900
NJ
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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