Individual
DR. HENRY LEE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
334 E HANES MILL RD, WINSTON SALEM, NC 27105-9135
(336) 450-2077
Mailing address
145 CROWNE CHASE DR APT 16, WINSTON SALEM, NC 27104-3582
(631) 671-1137
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10922
NC
Other
Enumeration date
02/07/2017
Last updated
10/23/2018
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