Jackson Dental, LLC

NPI #1932260338 in Jackson, Missouri

Provider Information

NPI Number: 1932260338
Entity Type: Organization
Organization Name: Jackson Dental, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 12, 2006
Last Updated: May 18, 2012

Practice Location

Address: 3100 E JACKSON BLVD
City: Jackson
State: Missouri
ZIP Code: 63755-2957
Phone: (573) 243-5200

Authorized Official

Name: KAY LYNN WELKER
Title: OFFICE ADMINISTRATOR
Phone: (573) 243-5200

Specialties & Taxonomy Codes

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

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