Provider Demographics
NPI:1427124288
Name:JACKSON SNIDER PARKER DENTISTRY, PLLC
Entity type:Organization
Organization Name:JACKSON SNIDER PARKER DENTISTRY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-671-2273
Mailing Address - Street 1:254 WEST RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2916
Mailing Address - Country:US
Mailing Address - Phone:734-671-2273
Mailing Address - Fax:734-786-2241
Practice Address - Street 1:254 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2916
Practice Address - Country:US
Practice Address - Phone:734-671-2273
Practice Address - Fax:734-786-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty