| Kyle R. Jackson, Dds, Llc | |
|
4090 Indian Ripple Rd Unit 102 Beavercreek OH 45440-3253 | |
| (937) 586-7729 | |
| (937) 490-9904 |
| Full Name | Kyle R. Jackson, Dds, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4090 Indian Ripple Rd Unit 102, Beavercreek, Ohio |
| Authorized Official Name and Position | Kyle R. Jackson (OWNER) |
| Authorized Official Contact | 9375867729 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kyle R. Jackson, Dds, Llc 273 Regency Ridge Dr Centerville OH 45459-4221 Ph: (937) 586-7729 | Kyle R. Jackson, Dds, Llc 4090 Indian Ripple Rd Unit 102 Beavercreek OH 45440-3253 Ph: (937) 586-7729 |
| NPI Number | 1710546437 |
|---|---|
| Provider Enumeration Date | 06/06/2019 |
| Last Update Date | 06/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710546437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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