Provider Demographics
NPI:1215554639
Name:DANA C. JACKSON, DDS., PLLC
Entity Type:Organization
Organization Name:DANA C. JACKSON, DDS., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-248-3810
Mailing Address - Street 1:2203 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4228
Mailing Address - Country:US
Mailing Address - Phone:301-248-3810
Mailing Address - Fax:301-449-6746
Practice Address - Street 1:2041 GEORGIA AVE NW STE 2066
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1361
Practice Address - Fax:202-865-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty