Individual
DR. THEODORE MICHAEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
305 W 12TH AVE, COLUMBUS, OH 43210-1267
(614) 247-6590
Mailing address
1254 N HIGH ST APT 307, COLUMBUS, OH 43201-2438
(618) 616-5324
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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