Provider Demographics
NPI:1386843050
Name:JACKSON, JAMES ANDREW (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
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 1:228 MAIN ST.
Mailing Address - Street 2:PO BOX 338
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858
Mailing Address - Country:US
Mailing Address - Phone:662-963-7338
Mailing Address - Fax:668-963-7339
Practice Address - Street 1:228 MAIN ST.
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858
Practice Address - Country:US
Practice Address - Phone:662-963-7338
Practice Address - Fax:668-963-7339
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3416-07122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist