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General NPI Number Information
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NPI Number | 1295928844
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Entity Type | Organization
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Legal Business Name | STEVEN C. JACKS, D.D.S., INC.
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 7111 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-2565
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Country | US
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Telephone | 937-277-8959
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Fax | 937-277-6161
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Provider Business Mailing Address
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Address Line | 7111 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-2565
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Country | US
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Telephone | 937-277-8959
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Fax | 937-277-6161
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN C. JACKS
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Credential | D.D.S.
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Telephone | 937-277-8959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19745
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License Number State | OH
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