Organization
JACKSON DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAY LYNN WELKER (OFFICE ADMINISTRATOR)
(573) 243-5200
Entity
Organization
Contact information
Practice address
3100 E JACKSON BLVD, JACKSON, MO 63755-2957
(573) 243-5200
Mailing address
3100 E JACKSON BLVD, JACKSON, MO 63755-2957
(573) 243-5200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
013049
MO
Other
Enumeration date
12/12/2006
Last updated
05/18/2012
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