Individual
DR. JACKSIE SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2819 E 29TH ST, JOPLIN, MO 64804
(417) 781-5530
Mailing address
2819 E 29TH ST, JOPLIN, MO 64804-9951
(417) 781-5530
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018013954
MO
Other
Enumeration date
07/13/2017
Last updated
07/05/2018
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