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General NPI Number Information
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NPI Number | 1144323205
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Entity Type | Organization
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Legal Business Name | DAVID B JACKSON DDS MS PLC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 433 W SEMINOLE ROAD SUITE #213
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City | MUSKEGON
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State | MI
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Zip | 49444
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Country | US
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Telephone | 231-739-7657
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Fax | 231-737-5107
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Provider Business Mailing Address
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Address Line | 433 W SEMINOLE ROAD SUITE #213
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City | MUSKEGON
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State | MI
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Zip | 49444
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Country | US
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Telephone | 231-739-7657
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Fax | 231-737-5107
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MELANIE J JACKSON
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Credential |
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Telephone | 231-739-7657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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