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General NPI Number Information
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NPI Number | 1922318195
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Entity Type | Organization
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Legal Business Name | ALFRED M. JACKSON DDS,MS PLLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 13731 STEELE CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28273
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Country | US
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Telephone | 704-464-0696
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Fax | 704-464-5630
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Provider Business Mailing Address
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Address Line | 13731 STEELE CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28273
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Country | US
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Telephone | 704-464-0696
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Fax | 704-464-5630
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALFRED MANWUEL JACKSON
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Credential | DDS
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Telephone | 704-464-0696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8527
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License Number State | NC
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