Individual
MELISSA D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
EDGEWOOD DENTAL, 7 MUNICIPAL WAY, EDGEWOOD, NM 87015
(505) 281-3406
Mailing address
PO BOX 913353, DENVER, CO 80291-2678
(505) 241-5182
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3828
NM
Other
Enumeration date
05/29/2013
Last updated
10/17/2024
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