Jackson, Courtney Matthew
Jackson, Courtney Matthew is an individual health care provider with primary practice located at 859 S Yellowstone Hwy Ste 1202 , Rexburg ID 83440-6201. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Jackson, Courtney Matthew can be contacted via phone (208) 552-5439.Contact Information
Primary practice address
859 S Yellowstone Hwy Ste 1202
Rexburg ID 83440-6201
Phone: (208) 552-5439
Fax: (208) 552-5440
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 1433 | Wyoming |
| Dental Providers / Pediatric Dentistry | 1223P0221X | D-4655-PD | Idaho |
Profile Details
| NPI number | 1972864825 |
|---|---|
| LBN Legal business name | Jackson, Courtney Matthew |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 6th, 2012 |
| Last updated | Feb 3rd, 2016 - about 10 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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