Organization
LJ DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH D JACKSON DMD (OWNER/DENTIST)
(309) 764-3242
Entity
Organization
Contact information
Practice address
2900 41ST ST, MOLINE, IL 61265-7823
(309) 764-3242
(309) 764-3267
Mailing address
2900 41ST ST, MOLINE, IL 61265-7823
(309) 764-3242
(309) 764-3267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
19015383
IL
1223G0001X
General Practice Dentistry
Primary
19026468
IL
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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