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General NPI Number Information
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NPI Number | 1598698201
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Entity Type | Individual
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Provider Name | ALYSON MARIE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 06/04/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 5611 NW 1ST ST STE 108
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City | LINCOLN
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State | NE
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Zip | 68521-4466
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Country | US
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Telephone | 402-438-5588
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 N 74TH ST
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City | LINCOLN
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State | NE
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Zip | 68507-2910
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Country | US
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Telephone | 402-314-9209
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8206
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License Number State | NE
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