Individual
BRIAN JAMES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3924 MARTIN WAY E, OLYMPIA, WA 98506-5220
(360) 456-8610
(360) 493-8179
Mailing address
3924 MARTIN WAY E, OLYMPIA, WA 98506-5220
(360) 456-8610
(360) 493-8179
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
6128
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5030374
—
WA
Enumeration date
11/14/2006
Last updated
10/07/2008
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