MEDICARE: DR. CHARLES JACKSON DMD

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	1223G0001X	General Practice Dentistry	35470	NY

General Provider Information

NPI Number	:	1982769840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES JACKSON DMD

Provider Business Mailing Address
First Line	:	3540 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5159
Country	:	US
Telephone Number	:	718-446-7100
Fax Number	:	718-446-8900

Provider Business Practice Location Address
First Line	:	3540 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5159
Country	:	US
Telephone Number	:	718-446-7100
Fax Number	:	718-446-8900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/08/2007

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1306045042 — DR. REKHA C GEHANI D.D.S.
Practice Location Address:

3540 82ND ST # 1F
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1598964231 — DR. CHANDURPAL P GEHANI B.D.S.
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1871770495 — REKHA CHANDURPAL GEHANI DENTIST P.C.
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1295968816 — DR. KIREN GEHANI DDS
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1598418832 — METROPOLITAN DENTAL & ANESTHESIOLOGY P.C.
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1851825038 — JULIE SIMPSON
Practice Location Address:

109 ABNER JACKSON PKWY , STE. B
LAKE JACKSON, TX
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Practice Phone: 979-297-9503
Practice Fax: 979-480-0254

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