Provider Demographics
NPI:1952320798
Name:JACKS, STEVEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:JACKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9167 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9521
Mailing Address - Country:US
Mailing Address - Phone:937-778-1623
Mailing Address - Fax:937-778-0359
Practice Address - Street 1:9167 N COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9521
Practice Address - Country:US
Practice Address - Phone:937-778-1623
Practice Address - Fax:937-778-0359
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH197451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005092Medicaid
OH956164OtherUNITED CONCORDIA/PROV.#
OH2005092Medicaid
OHJA0857451Medicare PIN