Individual
DR. STEVEN C. JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9167 N COUNTY ROAD 25A, PIQUA, OH 45356-9521
(937) 778-1623
(937) 778-0359
Mailing address
9167 N COUNTY ROAD 25A, PIQUA, OH 45356-9521
(937) 778-1623
(937) 778-0359
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
19745
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005092
—
OH
01
—
956164
UNITED CONCORDIA/PROV.#
OH
Enumeration date
07/19/2006
Last updated
09/27/2022
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