Organization
KENNETH J. JACKSON D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH J JACKSON (PRESIDENT)
(419) 738-2426
Entity
Organization
Contact information
Practice address
809 REDSKIN TRL, WAPAKONETA, OH 45895-8546
(419) 738-2426
Mailing address
809 REDSKIN TRL, WAPAKONETA, OH 45895-8546
(419) 738-2426
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20856
OH
Other
Enumeration date
04/22/2008
Last updated
04/22/2008
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