Provider Demographics
NPI:1881813798
Name:DR. DANIEL DEWEY JACKSON DDS
Entity type:Organization
Organization Name:DR. DANIEL DEWEY JACKSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-482-1744
Mailing Address - Street 1:277 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2058
Mailing Address - Country:US
Mailing Address - Phone:541-482-1744
Mailing Address - Fax:541-482-4128
Practice Address - Street 1:277 5TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2058
Practice Address - Country:US
Practice Address - Phone:541-482-1744
Practice Address - Fax:541-482-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD48361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty