Individual
DAVID MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3550 S 5600 W, SUITE 3, WEST VALLEY CITY, UT 84120-2776
(801) 966-3166
(801) 966-3179
Mailing address
3550 S 5600 W, SUITE 3, WEST VALLEY CITY, UT 84120-2734
(801) 966-3166
(801) 966-3179
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5138062
UT
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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