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General NPI Number Information
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NPI Number | 1689762569
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Entity Type | Organization
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Legal Business Name | RICHARD F. JACKSON, DDS, GREGORY HEISE, DDS, AND CRAIG ALPHA, DDS
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 2525 K ST SUITE 101
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City | SACRAMENTO
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State | CA
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Zip | 95816-5114
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Country | US
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Telephone | 916-442-1882
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Fax | 91-644-2303
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Provider Business Mailing Address
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Address Line | 2525 K ST SUITE 101
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City | SACRAMENTO
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State | CA
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Zip | 95816-5114
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Country | US
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Telephone | 916-442-1882
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Fax | 91-644-2303
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. MARGARET JACKSON
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Credential |
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Telephone | 916-961-0570
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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 | 24465
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License Number State | CA
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