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Contact Information

PATRICIA R JACKSON
191 HIGHWAY AND HOSPITAL ROAD
CHINLE, AZ86503
 Phone: 928-674-7166
 Fax: 928-674-7705
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for PATRICIA R JACKSON · (Female)

NPI # 1023377967
Status Active
Credentials
Entity Individual
Enumeration date 05/13/2012
Last updated 10/08/2013 - About 13 years ago
Sole proprietor 1 No
Identifiers
  • OH License # 30.023852
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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