Individual
DR. THEODORE MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.026788
OH
1223G0001X
General Practice Dentistry
19026503
IL
Other
Enumeration date
12/02/2005
Last updated
02/21/2023
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