| Centerille Pediatric Dentistry, Kyle R Jackson, Dds, Inc | |
|
273 Regency Ridge Dr Centerville OH 45459-4221 | |
| (937) 586-7729 | |
| (937) 660-4450 |
| Full Name | Centerille Pediatric Dentistry, Kyle R Jackson, Dds, Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 273 Regency Ridge Dr, Centerville, Ohio |
| Authorized Official Name and Position | Kyle R. Jackson (DENTIST/OWNER) |
| Authorized Official Contact | 9375867729 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerille Pediatric Dentistry, Kyle R Jackson, Dds, Inc 273 Regency Ridge Dr Centerville OH 45459-4221 Ph: (937) 586-7729 | Centerille Pediatric Dentistry, Kyle R Jackson, Dds, Inc 273 Regency Ridge Dr Centerville OH 45459-4221 Ph: (937) 586-7729 |
| NPI Number | 1386073112 |
|---|---|
| Provider Enumeration Date | 11/02/2013 |
| Last Update Date | 08/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386073112 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 30018976 (Ohio) | Primary |
Professional Dental Alliance Of Centerville, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9420 Dayton Lebanon Pike, Centerville, OH 45458 Phone: 937-433-8900 | |