Provider Demographics
NPI:1144323205
Name:DAVID B JACKSON DDS MS PLC
Entity type:Organization
Organization Name:DAVID B JACKSON DDS MS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-739-7657
Mailing Address - Street 1:433 W SEMINOLE ROAD
Mailing Address - Street 2:SUITE #213
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-739-7657
Mailing Address - Fax:231-737-5107
Practice Address - Street 1:433 W SEMINOLE ROAD
Practice Address - Street 2:SUITE #213
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-739-7657
Practice Address - Fax:231-737-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty