Provider Demographics
NPI:1861893067
Name:DAVID P JACKSON DDS, PC
Entity type:Organization
Organization Name:DAVID P JACKSON DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-447-2872
Mailing Address - Street 1:3393 IRIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5205
Mailing Address - Country:US
Mailing Address - Phone:303-447-2872
Mailing Address - Fax:303-447-2896
Practice Address - Street 1:3393 IRIS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5205
Practice Address - Country:US
Practice Address - Phone:303-447-2872
Practice Address - Fax:303-447-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty