Provider Demographics
NPI:1295387538
Name:WHITCOMB, JACKSON J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:J
Last Name:WHITCOMB
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 1:7070 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6272
Mailing Address - Country:US
Mailing Address - Phone:269-375-2856
Mailing Address - Fax:
Practice Address - Street 1:7070 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6272
Practice Address - Country:US
Practice Address - Phone:269-375-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901023177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist