Individual
DR. JOHN ANDREW JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
600 DIVISION AVE, SUITE E., SAN ANTONIO, TX 78214-1350
(210) 924-4279
(210) 924-4270
Mailing address
600 DIVISION AVE, SUITE E., SAN ANTONIO, TX 78214-1350
(210) 924-4279
(210) 924-4270
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D14522
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306300-05
—
TX
01
—
742713545
TAX ID
TX
01
—
784161
UNITED CONCORDIA
TX
Enumeration date
10/25/2006
Last updated
07/09/2007
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