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Individual

DR. COURTNEY MATTHEW JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
859 S YELLOWSTONE HWY STE 1202, REXBURG, ID 83440-6201
(208) 552-5439
(208) 552-5440
Mailing address
859 S YELLOWSTONE HWY STE 1202, REXBURG, ID 83440-6201
(208) 552-5439
(208) 552-5440

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
1433
WY
1223P0221X
Pediatric Dentistry
Primary
D-4655-PD
ID

Other

Enumeration date
06/06/2012
Last updated
02/03/2016
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