| Jackson Dental | |
|
3100 E Jackson Blvd Jackson MO 63755-2957 | |
| (573) 243-5200 | |
| (573) 243-7571 |
| Full Name | Jackson Dental |
|---|---|
| Speciality | Dentist |
| Location | 3100 E Jackson Blvd, Jackson, Missouri |
| Authorized Official Name and Position | Cody Bell (OWNER) |
| Authorized Official Contact | 5732435200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Dental 3100 E Jackson Blvd Jackson MO 63755-2957 Ph: (573) 243-5200 | Jackson Dental 3100 E Jackson Blvd Jackson MO 63755-2957 Ph: (573) 243-5200 |
| NPI Number | 1992136923 |
|---|---|
| Provider Enumeration Date | 12/02/2013 |
| Last Update Date | 12/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992136923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2011014478 (Missouri) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
Jackson Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3100 E Jackson Blvd, Jackson, MO 63755 Phone: 573-243-5200 |