Organization
TN DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN BLANE JACKSON DDS (DENTIST/ OWNER)
(602) 485-1588
Entity
Organization
Contact information
Practice address
4550 E BELL RD STE 102, PHOENIX, AZ 85032-9342
(602) 485-1588
(602) 707-9740
Mailing address
250 N FAIRGROUNDS RD STE 1, PRICE, UT 84501-4201
(435) 637-2100
(435) 612-0400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
12/20/2021
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