MEDICARE: STEVEN C. JACKS, D.D.S., 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	19745	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295928844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN C. JACKS, D.D.S., INC.

Provider Business Mailing Address
First Line	:	7111 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2565
Country	:	US
Telephone Number	:	937-277-8959
Fax Number	:	937-277-6161

Provider Business Practice Location Address
First Line	:	7111 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2565
Country	:	US
Telephone Number	:	937-277-8959
Fax Number	:	937-277-6161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN C. JACKS
Credential	:	D.D.S.
Telephone Number	:	937-277-8959

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	06/13/2013

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Directions to “STEVEN C. JACKS, D.D.S., INC. ” Practice Location

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