Organization
SCOTT ROBERT JACKSON DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT ROBERT JACKSON DDS PC (PRESIDENT)
(623) 933-0550
Entity
Organization
Contact information
Practice address
13660 N 94TH DR, SUITE A1 PLAZA DEL RIO MEDICAL CENTER, PEORIA, AZ 85381-4836
(623) 933-0550
(623) 933-2722
Mailing address
13660 N 94TH DR, SUITE #A1, PEORIA, AZ 85381-4836
(623) 933-0550
(623) 933-2722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2532
AZ
Other
Enumeration date
10/04/2006
Last updated
08/22/2020
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