Marylyn Jackson

NPI #1023359510 in Olympia Fields, Illinois

Provider Information

NPI Number: 1023359510
Entity Type: Individual
Name: Marylyn Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 7, 2013
Last Updated: Mar 7, 2013

Practice Location

Address: 2555 LINCOLN HWY
Address 2: SUITE 113
City: Olympia Fields
State: Illinois
ZIP Code: 60461-1936
Phone: (708) 679-0668

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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