Provider Demographics
NPI:1417339185
Name:JAMES ANDREW JACKSON, DDS, PLLC
Entity Type:Organization
Organization Name:JAMES ANDREW JACKSON, DDS, PLLC
Other - Org Name:JACKSON FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:O
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-895-7338
Mailing Address - Street 1:9035 EAST SANDIDGE RD, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:662-895-7338
Mailing Address - Fax:662-895-7040
Practice Address - Street 1:9035 E SANDIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3563
Practice Address - Country:US
Practice Address - Phone:662-895-7338
Practice Address - Fax:662-895-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3811-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty