Jackson Family Dental Gladstone LLC

NPI #1194115865 in Gladstone, Missouri

Provider Information

NPI Number: 1194115865
Entity Type: Organization
Organization Name: Jackson Family Dental Gladstone LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Feb 2, 2015
Last Updated: Feb 2, 2015

Practice Location

Address: 2109 NE 72ND ST
Address 2: STE 104
City: Gladstone
State: Missouri
ZIP Code: 64118-2304
Phone: (816) 453-3100

Authorized Official

Name: DR. JESSE LYNN JACKSON, D.D.S.
Title: MEMBER
Phone: (816) 429-5799

Specialties & Taxonomy Codes

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

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