Individual
DR. CHARLES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3540 82ND ST, JACKSON HEIGHTS, NY 11372-5159
(718) 446-7100
(718) 446-8900
Mailing address
3540 82ND ST, JACKSON HEIGHTS, NY 11372-5159
(718) 446-7100
(718) 446-8900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
35470
NY
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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