Jackson, Ron Darryl

Jackson, Ron Darryl is an individual health care provider with primary practice located at 5471 Dr Martin Luther King Dr , Saint Louis MO 63112-4265. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Jackson, Ron Darryl can be contacted via phone (314) 367-5820.

Contact Information

Primary practice address
5471 Dr Martin Luther King Dr Saint Louis MO 63112-4265
Phone: (314) 367-5820
Fax: (314) 367-7010
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 012608 Missouri

Profile Details

NPI number 1871586990
LBN Legal business name Jackson, Ron Darryl
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Jun 17th, 2010 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871586990 NPPES
Missouri MEDICAID 403231020
Missouri MEDICAID 403231038

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