Individual
KEITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7113 MIAMI AVE, MADEIRA, OH 45243-2616
(513) 561-5318
(513) 561-1120
Mailing address
7113 MIAMI AVE, MADEIRA, OH 45243-2616
(513) 561-5318
(513) 561-1120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30023286
OH
Other
Enumeration date
08/12/2010
Last updated
08/12/2010
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