Provider Demographics
NPI:1154392652
Name:JACKSON, ALISON KATE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:KATE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 SOQUEL DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3848
Mailing Address - Country:US
Mailing Address - Phone:831-662-2900
Mailing Address - Fax:
Practice Address - Street 1:7545 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3848
Practice Address - Country:US
Practice Address - Phone:831-662-2900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry