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General NPI Number Information
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NPI Number | 1952320798
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Entity Type | Individual
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Provider Name | STEVEN C. JACKS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 9167 N COUNTY ROAD 25A
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City | PIQUA
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State | OH
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Zip | 45356-9521
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Country | US
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Telephone | 937-778-1623
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Fax | 937-778-0359
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Provider Business Mailing Address
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Address Line | 9167 N COUNTY ROAD 25A
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City | PIQUA
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State | OH
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Zip | 45356-9521
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Country | US
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Telephone | 937-778-1623
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Fax | 937-778-0359
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19745
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License Number State | OH
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