Individual
DR. KEVEN PETER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS PC
Contact information
Practice address
22516 LINDEN BLVD, CAMBRIA HEIGHTS, NY 11411
(718) 978-0226
(718) 977-0281
Mailing address
22516 LINDEN BLVD, CAMBRIA HEIGHTS, NY 11411
(718) 978-0226
(718) 977-0281
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
040675
NY
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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