| Organization Name: | RALPH L. JACKSON, DDS, PC |
| NPI Number: | 1518108190 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RALPH L JACKSON (CEO) |
| Mailing Address: | 105 Highland Ave Cornelia |
| State: | GA US |
| Postal Code: | 305314366 |
| Phone Number: | 7067788645 |
| Fax Number: | 7067762650 |
| NPI Enumeration Date: | 03/12/2009 |
| NPI Last Update Date: | 06/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DN014968 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |