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General NPI Number Information
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NPI Number | 1235449919
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Entity Type | Organization
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Legal Business Name | C. JACKSON ALLAN DDS PC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 2414 W 7800 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-4292
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Country | US
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Telephone | 801-565-7455
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Fax | 801-569-1922
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Provider Business Mailing Address
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Address Line | 2414 W 7800 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-4292
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Country | US
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Telephone | 801-565-7455
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Fax | 801-569-1922
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. CRAIG JACKSON ALLAN
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Credential | DDS
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Telephone | 801-565-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5149430
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License Number State | UT
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