Provider Demographics
NPI:1376505578
Name:JACKSON, HARRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:JACKSON
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:TRIPLER ARMY MEDICAL CENTER
Mailing Address - Street 2:1 JARRETT WHITE ROAD
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:808-433-2444
Mailing Address - Fax:
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER
Practice Address - Street 2:1 JARRETT WHITE ROAD
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218041223G0001X
HI29621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice