Jackson, Richard K

Jackson, Richard K is an individual health care provider with primary practice located at 1975 Sansburys Way Ste 112 , West Palm Beach FL 33411-1928. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Jackson, Richard K can be contacted via phone (561) 737-6445.

Contact Information

Primary practice address
1975 Sansburys Way Ste 112 West Palm Beach FL 33411-1928
Phone: (561) 737-6445
Fax: (561) 792-5977
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DN12332 Florida

Profile Details

NPI number 1629046339
LBN Legal business name Jackson, Richard K
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 9th, 2006
Last updated Feb 13th, 2020 - about 4 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 1629046339 NPPES
Florida MEDICAID 073772100

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