Provider Demographics
NPI:1487176186
Name:JACKSON, MEGAN BENDER (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BENDER
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 1:14615 GERONIMO LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-6739
Mailing Address - Country:US
Mailing Address - Phone:832-213-7390
Mailing Address - Fax:
Practice Address - Street 1:6915 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7739
Practice Address - Country:US
Practice Address - Phone:281-997-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist