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NPI Code Detail

MEDICARE: DONALD JACKMAN D.D.S.

MEDICARE: DONALD JACKMAN D.D.S.
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
1122300000XDentist16198TX

General Provider Information

NPI Number : 1124023395
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD JACKMAN D.D.S.
Provider Business Mailing Address
First Line : 8029 ETIENNE DR
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78414-6027
Country : US
Telephone Number : 361-299-5777
Fax Number :
Provider Business Practice Location Address
First Line : 109 E AVENUE J
Second Line :
City : ROBSTOWN
State : TX
Zip : 78380-2347
Country : US
Telephone Number : 361-387-1531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 07/09/2007

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