Healthcare Provider Details

I. General information

NPI: 1598698201
Provider Name (Legal Business Name): ALYSON MARIE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5611 NW 1ST ST STE 108
LINCOLN NE
68521-4466
US

IV. Provider business mailing address

2801 N 74TH ST
LINCOLN NE
68507-2910
US

V. Phone/Fax

Practice location:
  • Phone: 402-438-5588
  • Fax:
Mailing address:
  • Phone: 402-314-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8206
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: