Provider Demographics
NPI:1588133441
Name:JAMES D. JACKSON DDS PC
Entity type:Organization
Organization Name:JAMES D. JACKSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-9070
Mailing Address - Street 1:101 S FRONT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4641
Mailing Address - Country:US
Mailing Address - Phone:906-228-9070
Mailing Address - Fax:906-356-3400
Practice Address - Street 1:101 S FRONT ST STE 201
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4641
Practice Address - Country:US
Practice Address - Phone:906-228-9070
Practice Address - Fax:906-356-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568517944OtherINDIVIDUAL NPI