Jackson, Theodore Michael

Jackson, Theodore Michael is an individual health care provider with primary practice located at 305 W 12Th Ave , Columbus OH 43210-1267. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is his primary health care specialty. Jackson, Theodore Michael can be contacted via phone (614) 247-6590.

Contact Information

Primary practice address
305 W 12Th Ave Columbus OH 43210-1267
Phone: (614) 247-6590
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 19026503 Illinois
Dental Providers / Dentist 122300000X 30.026788 Ohio

Profile Details

NPI number 1912981945
LBN Legal business name Jackson, Theodore Michael
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 2nd, 2005
Last updated Feb 21st, 2023 - about 3 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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