Doralia A Jackson in Great Lakes - Dentist
Doralia A Jackson - NPI 1194705293
Doralia A Jackson is a Dentist in Great Lakes, Illinois. Doralia A Jackson practices all healthcare services and medical treatments related to Dentist. The NPI Number for Doralia A Jackson is 1194705293. The last update date is 2007-07-08.
Doralia A Jackson's current location address is 3001a Sixth St., Great Lakes, Illinois. You can contact this provider via phone number 8476882100. The mailing address for Doralia A Jackson is 3001a Sixth St., Great Lakes, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Doralia A Jackson |
|---|---|
| Address | 3001a Sixth St., Great Lakes, Illinois |
| Phone Number | 8476882100 |
| Fax Number | |
| Sole Proprietor | X |
| Credentials | DDS |
NPI Number Detail
| NPI Number | 1194705293 |
|---|---|
| Provider Enumeration Date | 2006-01-17 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 3001a Sixth St. |
|---|---|
| City | Great Lakes |
| State | Illinois (IL) |
| Post Code | 600882833 |
| Phone Number | 8476882100 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
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Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
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What is the unique 10-digit identification code assigned to Doralia A Jackson by the Centers for Medicare & Medicaid Services?
The Doralia A Jackson has been issued the NPI (National Provider Identifier) 1194705293, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Doralia A Jackson's physical address?
The Doralia A Jackson is physically located at 3001A Sixth St., in the city of Great Lakes, IL, with the postal code 600882833.
What is Doralia A Jackson's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Doralia A Jackson's specialized field of practice is Dentist, and the corresponding taxonomy code that categorizes this area of specialization is 122300000X.
On what date did the Doralia A Jackson receive its 1194705293 assignment from the Centers for Medicare & Medicaid Services?
The Doralia A Jackson was assigned its 1194705293 by the Centers for Medicare & Medicaid Services on 2006-01-17.
When was the information related to Doralia A Jackson most recently updated or refreshed?
The details pertaining to the Doralia A Jackson, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.