Jackson, Mark K
Jackson, Mark K is an individual health care provider with primary practice located at 7007 Old Sauk Road , Madison WI 53717. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Jackson, Mark K can be contacted via phone (608) 833-2060.Contact Information
Primary practice address
7007 Old Sauk Road
Madison WI 53717
Phone: (608) 833-2060
Fax: (608) 833-1737
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 3459 | Wisconsin |
Profile Details
| NPI number | 1598788796 |
|---|---|
| LBN Legal business name | Jackson, Mark K |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598788796 | NPPES |
| Wisconsin | MEDICAID | 33475100 |
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