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General NPI Number Information
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NPI Number | 1992757728
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Entity Type | Individual
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Provider Name | LINDA A JACKSON DDS
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 03/09/2014
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Provider Practice Location Address
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Address Line | 301 BECKER AVE SW RICE REGIONAL DENTAL CLINIC
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City | WILLMAR
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State | MN
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Zip | 56201-3302
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Country | US
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Telephone | 320-214-2620
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Fax | 320-214-2630
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Provider Business Mailing Address
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Address Line | 301 BECKER AVE SW
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City | WILLMAR
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State | MN
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Zip | 56201-3302
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Country | US
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Telephone | 320-214-2620
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Fax | 320-214-2630
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019020810
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | FF46
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License Number State | MN
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