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Individual

DR. SHELBY ELLIS JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
6800 MAIN ST, DOWNERS GROVE, IL 60516-3493
(630) 969-5350
Mailing address
530 N NORTH SHORE CT, LAKE ORION, MI 48362-3067
(586) 337-2395

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
019.034067
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021.003305
IL

Other

Enumeration date
10/10/2023
Last updated
01/10/2024
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