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General NPI Number Information
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NPI Number | 1356694897
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Entity Type | Individual
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Provider Name | JAMAR MAURICE JACKSON DMD
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Gender | Male
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 80 GROVE ST
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City | RIDGEFIELD
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State | CT
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Zip | 06877-4104
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Country | US
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Telephone | 203-438-7280
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Fax |
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Provider Business Mailing Address
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Address Line | 77 HARRISONS TRL
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City | HOPEWELL JCT
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State | NY
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Zip | 12533-3223
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Country | US
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Telephone | 347-249-7736
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10775
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License Number State | CT
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