Provider Demographics
NPI:1649492059
Name:DAWN A JACKSON-BREEDEN DMD LTD
Entity type:Organization
Organization Name:DAWN A JACKSON-BREEDEN DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-439-4391
Mailing Address - Street 1:300 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1042
Mailing Address - Country:US
Mailing Address - Phone:618-439-4391
Mailing Address - Fax:
Practice Address - Street 1:405 E PARK ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1971
Practice Address - Country:US
Practice Address - Phone:618-439-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty