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1265570683
KEVIN R JACKSON
POWDER SPRINGS, GA
NPI
1265570683
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223P0221X Dentist, Pediatric Dentistry
(Licence: GA DN012902)
Enumeration Date
2007-02-01
Last Update Date
2007-07-10
Business Address
-- KEVIN R JACKSON DDS
4150 MACLAND RD SUITE 205
POWDER SPRINGS, GA 30127-1202
Phone number: 770-222-1344
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Mailing Address
-- KEVIN R JACKSON DDS
5605 MAXON MARSH DR
HIRAM, GA 30141-2880
Phone number:
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