Individual
DR. MELISSA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2539 S COLUMBIA PL, TULSA, OK 74114-3232
(504) 638-6479
Mailing address
2539 S COLUMBIA PL, TULSA, OK 74114-3232
(504) 638-6479
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6850
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6850
OKLAHOMA DENTAL BOARD
OK
Enumeration date
03/04/2015
Last updated
03/07/2023
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