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Provider Information for 1891954566



DR. JONATHAN D JACKSON D.D.S.

Gender: MALE

Individual NPI: 1891954566

Calendar Last Updated: 2008-07-23

Details

Name Value
NPI 1891954566
Enumeration Date 2008-06-06
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 51 N 850 E
LINDON, UT 84042-2154
United States

Phone: 304-288-4574 | Fax:
View Map External Link
Primary Practice Address 335 E 400 S
SPRINGVILLE, UT 84663-1959
United States

Phone: 801-489-4411 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice UT 7025515-9921