Provider Demographics
NPI:1801007919
Name:JACKSON, JOHN TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TODD
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:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1583
Mailing Address - Country:US
Mailing Address - Phone:603-423-0400
Mailing Address - Fax:603-423-0401
Practice Address - Street 1:382 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-1583
Practice Address - Country:US
Practice Address - Phone:603-423-0400
Practice Address - Fax:603-423-0401
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics