Provider Demographics
NPI:1881908622
Name:DR. DAVID E. JACKSON DDS PC
Entity type:Organization
Organization Name:DR. DAVID E. JACKSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-571-8391
Mailing Address - Street 1:870 E 9400 S
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3666
Mailing Address - Country:US
Mailing Address - Phone:801-571-8391
Mailing Address - Fax:801-571-8285
Practice Address - Street 1:870 E 9400 S
Practice Address - Street 2:SUITE #110
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3666
Practice Address - Country:US
Practice Address - Phone:801-571-8391
Practice Address - Fax:801-571-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138455-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty