Organization
BRUCE A. JACKSON II, DDS, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE JACKSON II DDS (OWNER)
(616) 363-8707
Entity
Organization
Contact information
Practice address
4829 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-9747
(616) 363-8707
Mailing address
4829 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-9747
(616) 363-8707
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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