Provider Demographics
NPI:1679370498
Name:JACKSON, MALIK AR (DDS)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:AR
Last Name:JACKSON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18104 E ALABAMA PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5760
Mailing Address - Country:US
Mailing Address - Phone:970-462-5283
Mailing Address - Fax:
Practice Address - Street 1:1700 WHEELING ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7211
Practice Address - Country:US
Practice Address - Phone:720-723-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program