Provider Demographics
NPI:1619541562
Name:SAVAGE, JACKSON DAVID (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:DAVID
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 LIVE OAK ST APT 338
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5875
Mailing Address - Country:US
Mailing Address - Phone:214-709-0311
Mailing Address - Fax:
Practice Address - Street 1:205 S STATE HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-7504
Practice Address - Country:US
Practice Address - Phone:830-372-9811
Practice Address - Fax:830-303-0149
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics