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NPI Code Detail

MEDICARE: JACKSON AND LEE DENTAL CORPORATION

MEDICARE: JACKSON AND LEE DENTAL CORPORATION
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 Dentistry

General Provider Information

NPI Number : 1881758241
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSON AND LEE DENTAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 920050
Second Line :
City : DALLAS
State : TX
Zip : 75392-0050
Country : US
Telephone Number : 714-508-3600
Fax Number : 714-368-2092
Provider Business Practice Location Address
First Line : 40484 MURRIETA HOT SPRINGS RD
Second Line : STE. 102
City : MURRIETA
State : CA
Zip : 92563-6400
Country : US
Telephone Number : 951-461-4306
Fax Number : 951-461-4735
Authorized Official
Title or Position : OWNER DDS
Name : DR. JONATHAN JACKSON
Credential : DDS
Telephone Number : 951-461-4306
Provider Enumeration Date : 12/20/2006
Last Update Date : 05/11/2022

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Directions to “JACKSON AND LEE DENTAL CORPORATION ” Practice Location

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