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NPI Code Detail

MEDICARE: DR. WILLIAM G. JACKSON JR. DDS INC

MEDICARE: DR. WILLIAM G. JACKSON JR. DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist30015160OH

General Provider Information

NPI Number : 1033214846
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. WILLIAM G. JACKSON JR. DDS INC
Provider Business Mailing Address
First Line : 7113 MIAMI AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45243-2616
Country : US
Telephone Number : 513-561-5318
Fax Number : 513-561-1120
Provider Business Practice Location Address
First Line : 7113 MIAMI AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45243-2616
Country : US
Telephone Number : 513-561-5318
Fax Number : 513-561-1120
Authorized Official
Title or Position : OWNER
Name : DR. WILLIAM G JACKSON JR.
Credential : DDS
Telephone Number : 513-561-5318
Provider Enumeration Date : 09/14/2006
Last Update Date : 08/22/2020

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