Individual
DR. JOSEPH C JACKSON JR.
Active
Individual
DR. JOSEPH C JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,PA
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN5413
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
075453600
—
FL
05
—
075453601
—
FL
01
—
59-2061906
TAX ID
FL
01
—
85760
BCBS
FL
01
—
DN5413
STATE LICENSE
FL
Enumeration date
04/04/2007
Last updated
08/11/2020
Update your record
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