Individual
DR. MICHAEL D JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
309 N. SHERIDAN RD, LAWTON, OK 73505
(580) 357-7878
(580) 357-1963
Mailing address
910 NW MICKLEGATE BLVD, LAWTON, OK 73505-4134
(580) 536-1219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
OK4831
OK
Other
Enumeration date
08/11/2005
Last updated
07/08/2007
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