Individual
LINDA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
301 BECKER AVE SW, RICE REGIONAL DENTAL CLINIC, WILLMAR, MN 56201-3302
(320) 214-2620
(320) 214-2630
Mailing address
301 BECKER AVE SW, WILLMAR, MN 56201-3302
(320) 214-2620
(320) 214-2630
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019020810
IL
122300000X
Dentist
Primary
FF46
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382100500
—
MN
01
—
585241041522
PREFERRED ONE
—
Enumeration date
05/17/2006
Last updated
03/09/2014
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