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General NPI Number Information
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NPI Number | 1780992586
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Entity Type | Organization
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Legal Business Name | FURQUERON & JACKSON DENTISTRY PARTNERSHIP
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 1910 STATE HWY 43 EAST
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City | HENDERSON
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State | TX
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Zip | 75652
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Country | US
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Telephone | 903-657-3139
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Fax | 903-655-0699
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Provider Business Mailing Address
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Address Line | 1910 STATE HWY 43 EAST
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City | HENDERSON
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State | TX
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Zip | 75652
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Country | US
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Telephone | 903-657-3139
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Fax | 903-655-0699
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | BRIAN C JACKSON
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Credential | D.D.S.
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Telephone | 903-657-3139
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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 | 19316
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License Number State | TX
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