Jackson, Joseph C

Jackson, Joseph C is an sole proprietor health care provider with primary practice located at 147 2Nd Ave S Ste 308 , Saint Petersburg FL 33701-4393. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Jackson, Joseph C can be contacted via phone (727) 415-6389.

Contact Information

Primary practice address
147 2Nd Ave S Ste 308 Saint Petersburg FL 33701-4393
Phone: (727) 415-6389
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X DN5413 Florida

Profile Details

NPI number 1801918602
LBN Legal business name Jackson, Joseph C
Credentials DDS,PA
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 4th, 2007
Last updated Aug 11th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801918602 NPPES
Florida Other 85760 BCBS
Florida MEDICAID 075453601 BCBS
Florida MEDICAID 075453600 BCBS
Florida Other 59-2061906 BCBS
Florida Other DN5413 BCBS

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