Individual
SARA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8217 WICKER AVE, SAINT JOHN, IN 46373-8878
(219) 322-9920
Mailing address
8217 WICKER AVE, SAINT JOHN, IN 46373-8878
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013150A
IN
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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