Dr Marilyn D Jackson & Associates Ltd | |
1705 E Sauk Trl Sauk Village IL 60411-4955 | |
(708) 757-3100 | |
(708) 757-3272 |
Full Name | Dr Marilyn D Jackson & Associates Ltd |
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Speciality | Dentist |
Location | 1705 E Sauk Trl, Sauk Village, Illinois |
Authorized Official Name and Position | Marilyn Denise Jackson (DENTIST PRESIDENT OF CORPORATION) |
Authorized Official Contact | 7087573100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Dr Marilyn D Jackson & Associates Ltd Po Box 1893 Chicago Heights IL 60412-1893 Ph: (708) 757-3100 | Dr Marilyn D Jackson & Associates Ltd 1705 E Sauk Trl Sauk Village IL 60411-4955 Ph: (708) 757-3100 |
NPI Number | 1336123041 |
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Provider Enumeration Date | 12/06/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336123041 | NPI | - | NPPES |
1002324 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 01917207 (Illinois) | Primary |
122300000X | Dentist | 12009402 (Indiana) | Secondary |