Individual
DR. BRIAN E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2775 BISHOP RD, SUITE C, WILLOUGHBY HILLS, OH 44092-2683
(440) 944-7775
(440) 944-7887
Mailing address
2775 BISHOP RD, SUITE C, WILLOUGHBY HILLS, OH 44092-2683
(440) 944-7775
(440) 944-7887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19620
OH
332B00000X
Durable Medical Equipment & Medical Supplies
19620
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0879287
—
OH
Enumeration date
11/01/2005
Last updated
04/24/2019
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