Organization
JACKSON FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE LYNN JACKSON DDS (OWNER)
(816) 429-5799
Entity
Organization
Contact information
Practice address
8650 NE SHOAL CREEK VALLEY DRIVE, KANSAS CITY, MO 64157
(816) 429-5799
(816) 245-7867
Mailing address
26 S VILLAGE DR, LIBERTY, MO 64068-2457
(816) 429-5799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
02/02/2015
Last updated
10/08/2025
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