Provider Demographics
NPI:1588876965
Name:JACKSON, DONALD MURPHY (DDS,PA)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MURPHY
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-4126
Mailing Address - Country:US
Mailing Address - Phone:410-287-8644
Mailing Address - Fax:410-287-1542
Practice Address - Street 1:712 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-4126
Practice Address - Country:US
Practice Address - Phone:410-287-8644
Practice Address - Fax:410-287-1542
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist