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NPI Code Detail

MEDICARE: DR. LEONARD JOSEPH JACKO JR. D.D.S.

MEDICARE: DR. LEONARD JOSEPH JACKO JR. 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
11223G0001XGeneral Practice Dentistry21436OH

General Provider Information

NPI Number : 1689677676
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEONARD JOSEPH JACKO JR. D.D.S.
Provider Business Mailing Address
First Line : 10701 EAST BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1702
Country : US
Telephone Number : 216-791-3800
Fax Number :
Provider Business Practice Location Address
First Line : 10701 EAST BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1702
Country : US
Telephone Number : 216-791-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/11/2023

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