Provider Demographics
NPI:1760485759
Name:JACKO, ANNE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:JACKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N LEAVITT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1174
Mailing Address - Country:US
Mailing Address - Phone:440-988-2615
Mailing Address - Fax:440-988-5949
Practice Address - Street 1:199 N LEAVITT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1174
Practice Address - Country:US
Practice Address - Phone:440-988-2615
Practice Address - Fax:440-988-5949
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH218811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice