Provider Demographics
NPI:1598028607
Name:JACKSON, JULIUS DEON (DMD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:DEON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9672 SYCAMORE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-1813
Mailing Address - Country:US
Mailing Address - Phone:909-379-8262
Mailing Address - Fax:
Practice Address - Street 1:69160 RAMON RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-9140
Practice Address - Country:US
Practice Address - Phone:760-969-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist