Organization
J. ANDREW JACKSON, D.D.S. LTD., LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY ADAMITZ (OFFICE MGR.)
(210) 924-4279
Entity
Organization
Contact information
Practice address
600 DIVISION, SUITE E., SAN ANTONIO, TX 78214
(210) 924-4279
(210) 924-4270
Mailing address
600 DIVISION, SUITE E., SAN ANTONIO, TX 78214
(210) 924-4279
(210) 924-4270
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
14522
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306300-05
—
TX
01
—
56539501
AETNA
TX
01
—
651906
PMI DELTA CARE
TX
01
—
784161
UNITED CONCORDIA
TX
Enumeration date
02/12/2010
Last updated
02/12/2010
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