Organization
J. ANDREW JACKSON, D.D.S. LTD., LLP
Active
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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