Jack T Ackerman, DDS
Individual provider Active NPI General Practice Dentistry · Bloomington, CA
NPI 1922084276 · NPPES record last updated Aug 6, 2007
Key facts
- NPI
- 1922084276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 35370 (CA)
- Practice address
- 19059 Valley Blvd
Suite 103
Bloomington, CA 92316-2219 - Phone
- (909) 877-3660
- Fax
- (909) 877-3682
- NPI assigned
- Dec 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35370 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 35370 | CA | Yes |
Addresses
Primary practice location
19059 Valley Blvd
Suite 103
Bloomington, CA 92316-2219
Mailing address
19059 Valley Blvd
Suite 103
Bloomington, CA 92316-2219
Phone (909) 877-3660
Other providers in Bloomington, CA
- Hamza Abdallah
- Karina M Aceves
- Act Healthcare Services
- Acts for Children
- Taiwo Olanike Adams
- Tammy Ahumada
- Robert John B Albino
All providers in Bloomington, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.