Organization
MAC JACKSON III DMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN PUGH (PRACTICE MANAGER)
(360) 256-7455
Entity
Organization
Contact information
Practice address
13115 NE 4TH ST STE 250, VANCOUVER, WA 98684-5960
(541) 490-9126
Mailing address
13115 NE 4TH ST STE 250, VANCOUVER, WA 98684-5960
(541) 490-9126
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/24/2026
Last updated
05/08/2026
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