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General NPI Number Information
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NPI Number | 1245858083
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Entity Type | Organization
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Legal Business Name | JACKO & SIEFKER DDS, LLC
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 210 HERITAGE DR
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City | WELLINGTON
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State | OH
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Zip | 44090-8949
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Country | US
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Telephone | 440-647-2752
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Fax |
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Provider Business Mailing Address
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Address Line | 210 HERITAGE DR
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City | WELLINGTON
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State | OH
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Zip | 44090-8949
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Country | US
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Telephone | 440-647-2752
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JONATHAN R SIEFKER
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Credential | DDS
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Telephone | 440-647-2752
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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 |
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License Number State |
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