Provider Demographics
NPI:1285798512
Name:JACKSON, WILLIAM T K (DDS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T K
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2 CLARION CT
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2653
Mailing Address - Country:US
Mailing Address - Phone:410-256-7300
Mailing Address - Fax:410-529-0951
Practice Address - Street 1:10151 YORK ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3314
Practice Address - Country:US
Practice Address - Phone:410-667-4222
Practice Address - Fax:410-667-4494
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice