Jackson Dental Prof. LLC

NPI #1144394545 in Belle Fourche, South Dakota

Provider Information

NPI Number: 1144394545
Entity Type: Organization
Organization Name: Jackson Dental Prof. LLC
Primary Specialty: Dentist
Enumeration Date: Nov 17, 2006
Last Updated: Nov 3, 2010

Practice Location

Address: 503 JACKSON ST
City: Belle Fourche
State: South Dakota
ZIP Code: 57717
Phone: (605) 892-6347

Authorized Official

Name: CHRISTOPHER J JACKSON, DMD
Title: PRESIDENT
Phone: (605) 892-6347

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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