Provider Demographics
NPI:1396468690
Name:THE DENTAL OFFICE JACKSON
Entity type:Organization
Organization Name:THE DENTAL OFFICE JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-371-9712
Mailing Address - Street 1:604 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1646
Mailing Address - Country:US
Mailing Address - Phone:507-847-3910
Mailing Address - Fax:507-847-2868
Practice Address - Street 1:604 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1646
Practice Address - Country:US
Practice Address - Phone:507-847-3910
Practice Address - Fax:507-847-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental