| Robert C Jackson Ii D.d.s. Pc | |
|
59 North Main Street Earlville NY 13332 | |
| (315) 691-6502 | |
| (315) 691-3119 |
| Full Name | Robert C Jackson Ii D.d.s. Pc |
|---|---|
| Speciality | Dentist |
| Location | 59 North Main Street, Earlville, New York |
| Authorized Official Name and Position | Robert Charles Jackson (OWNER) |
| Authorized Official Contact | 3156916502 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert C Jackson Ii D.d.s. Pc P.o. Box 360 59 North Main Street Earlville NY 13332 Ph: (315) 691-6502 | Robert C Jackson Ii D.d.s. Pc 59 North Main Street Earlville NY 13332 Ph: (315) 691-6502 |
| NPI Number | 1760861421 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 05/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760861421 | NPI | - | NPPES |
| 00914058 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 038574 (New York) | Primary |
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