| Dr Marilyn D Jackson & Associates Ltd | |
|
1705 E Sauk Trl Sauk Village IL 60411-4955 | |
| (708) 757-3100 | |
| (708) 757-3272 |
| Full Name | Dr Marilyn D Jackson & Associates Ltd |
|---|---|
| Speciality | Dentist |
| Location | 1705 E Sauk Trl, Sauk Village, Illinois |
| Authorized Official Name and Position | Marilyn Denise Jackson (DENTIST PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 7087573100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Marilyn D Jackson & Associates Ltd Po Box 1893 Chicago Heights IL 60412-1893 Ph: (708) 757-3100 | Dr Marilyn D Jackson & Associates Ltd 1705 E Sauk Trl Sauk Village IL 60411-4955 Ph: (708) 757-3100 |
| NPI Number | 1336123041 |
|---|---|
| Provider Enumeration Date | 12/06/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336123041 | NPI | - | NPPES |
| 1002324 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12009402 (Indiana) | Secondary |
| 122300000X | Dentist | 01917207 (Illinois) | Primary |