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General NPI Number Information
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NPI Number | 1063601995
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Entity Type | Organization
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Legal Business Name | JENNIFER C. JACKSON, DMD, MPH, P.A.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 76 PEACHTREE RD SUITE 100
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City | ASHEVILLE
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State | NC
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Zip | 28803-3131
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Country | US
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Telephone | 828-277-6788
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Fax | 828-277-6798
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Provider Business Mailing Address
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Address Line | 76 PEACHTREE RD SUITE 100
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City | ASHEVILLE
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State | NC
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Zip | 28803-3131
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Country | US
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Telephone | 828-277-6788
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Fax | 828-277-6798
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/OWNER
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Name | DR. JENNIFER C. JACKSON
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Credential | DMD, MPH
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Telephone | 828-277-6788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7888
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License Number State | NC
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