Jackson, Matthew J
Jackson, Matthew J is an individual health care provider with primary practice located at 243 Charles Street Mass Eye And Ear Infirmary, Boston MA 02114. He recently has only one registered license in Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery, which is considered as his primary health care specialty. Jackson, Matthew J can be contacted via phone (617) 573-4306.Contact Information
Primary practice address
243 Charles Street Mass Eye And Ear Infirmary
Boston MA 02114
Phone: (617) 573-4306
Fax: (617) 659-4917
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | 11607 | Massachusetts |
Profile Details
| NPI number | 1588647911 |
|---|---|
| LBN Legal business name | Jackson, Matthew J |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 21st, 2005 |
| Last updated | Jul 8th, 2007 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588647911 | NPPES |
| Massachusetts | MEDICAID | 0264822 | |
| Massachusetts | Other | 40346 | |
| Massachusetts | Other | 757863 |
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