Individual
JONATHAN MATTHEW JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3501 TERRACE ST, PITTSBURGH, PA 15213-2523
(412) 648-8595
Mailing address
2984 SIDNEY ST APT 329, PITTSBURGH, PA 15203-5148
(301) 807-3949
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DS043562
PA
Other
Enumeration date
05/09/2024
Last updated
05/09/2024
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