Individual
DOUGLASS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1959 NE PACIFIC ST, HSB-B221, SEATTLE, WA 98195-0001
(206) 685-2937
(206) 616-8577
Mailing address
1959 NE PACIFIC ST, PO BOX 357131, SEATTLE, WA 98195-0001
(206) 685-2937
(206) 616-8577
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DF30000048
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143782
L AND I
WA
05
—
5029897
—
WA
Enumeration date
10/12/2006
Last updated
07/09/2007
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