Provider Demographics
NPI:1033214846
Name:DR. WILLIAM G. JACKSON JR. DDS INC
Entity Type:Organization
Organization Name:DR. WILLIAM G. JACKSON JR. DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-561-5318
Mailing Address - Street 1:7113 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2616
Mailing Address - Country:US
Mailing Address - Phone:513-561-5318
Mailing Address - Fax:513-561-1120
Practice Address - Street 1:7113 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2616
Practice Address - Country:US
Practice Address - Phone:513-561-5318
Practice Address - Fax:513-561-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty