Provider Demographics
NPI:1447483524
Name:JACKSON AND JOYCE FAMILY DENTISTRY PL
Entity type:Organization
Organization Name:JACKSON AND JOYCE FAMILY DENTISTRY PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-732-8544
Mailing Address - Street 1:1910 SE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8312
Mailing Address - Country:US
Mailing Address - Phone:352-732-8544
Mailing Address - Fax:352-732-6855
Practice Address - Street 1:1910 SE 18TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8312
Practice Address - Country:US
Practice Address - Phone:352-732-8544
Practice Address - Fax:352-732-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN001-4031122300000X
FLDN151-85122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty