| Jackson Pediatric Dentistry | |
|
3233 63rd St Suite A Lubbock TX 79413-5742 | |
| (806) 789-9870 | |
| Not Available |
| Full Name | Jackson Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3233 63rd St, Lubbock, Texas |
| Authorized Official Name and Position | Cecily Lynn Jackson (REGISTERED AGENT/DIRECTOR) |
| Authorized Official Contact | 8067899870 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Pediatric Dentistry 21 W Lakeshore Dr Ransom Canyon TX 79366-2517 Ph: () - | Jackson Pediatric Dentistry 3233 63rd St Suite A Lubbock TX 79413-5742 Ph: (806) 789-9870 |
| NPI Number | 1053667451 |
|---|---|
| Provider Enumeration Date | 08/03/2012 |
| Last Update Date | 08/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053667451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 24654 (Texas) | Primary |
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