Jerry Jack, DDS

NPI #1265463467 in Moore, Oklahoma

Provider Information

NPI Number: 1265463467
Entity Type: Individual
Name: Jerry Jack, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: DDS
Enumeration Date: Jul 5, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1740 N SERVICE RD
City: Moore
State: Oklahoma
ZIP Code: 73160-3307
Phone: (405) 794-7200

Specialties & Taxonomy Codes

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

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