Organization
MIDWAY FAMILY DENTAL
Active
Other names
RB Jackson, III DMD
Organization subpart
No
Provider details
NPI number
Authorized official
ROLLIN B JACKSON D.M.D. (OWNER)
(912) 880-2288
Entity
Organization
Contact information
Practice address
1718 N COASTAL HWY, MIDWAY, GA 31320-3415
(912) 880-2288
(912) 880-2110
Mailing address
PO BOX 134, MIDWAY, GA 31320-0134
(912) 880-2288
(912) 880-2110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
013091
GA
1223G0001X
General Practice Dentistry
014447
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
014574
GA
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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