Individual
AMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14855 BLANCO RD STE 109, SAN ANTONIO, TX 78216-7728
(210) 493-6067
Mailing address
14855 BLANCO RD STE 109, SAN ANTONIO, TX 78216-7728
(210) 493-6067
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22622
TX
Other
Enumeration date
12/11/2006
Last updated
07/06/2011
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