Provider Demographics
NPI:1205018611
Name:OSAKWE, JACKSON (DDS)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:OSAKWE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7324 GASTON AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6126
Mailing Address - Country:US
Mailing Address - Phone:214-327-0300
Mailing Address - Fax:214-327-0307
Practice Address - Street 1:7324 GASTON AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6126
Practice Address - Country:US
Practice Address - Phone:214-327-0300
Practice Address - Fax:214-327-0307
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice