Most Relevant Information
Provider Data
| NPI Number: | 1003071697 |
| Provider Name: | WAYNE PAUL JACKMAN DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 019126 |
Most Important Dates
| Enumeration Date: | 07/23/2008 |
| Last Updated: | 07/23/2008 |
Provider Practice Location
444 S MERIDIAN ST
RAVENA
OH
44233
Practice Location Phone/Fax
| Phone: | 3302976216 |
| Fax: |
Provider Mailing Location
444 S MERIDIAN ST
RAVENNA
OH
44266
Provider Mailing Phone/Fax
| Phone: | 3302976216 |
| Fax: | 3302975803 |