Individual
DR. RICHARD M JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
505 S MAIN, PORTER, OK 74454
(918) 483-0012
(918) 483-4174
Mailing address
PO BOX 334, PORTER, OK 74454-0334
(918) 483-0213
(918) 483-4174
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5920
OK
Other
Enumeration date
11/16/2009
Last updated
01/05/2012
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