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Individual
DR. AMANDA JACKSON
Active
Individual
DR. AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
54679
CA
1223G0001X
General Practice Dentistry
8846
KY
1223G0001X
General Practice Dentistry
Primary
DE 60447313
WA
Other
Enumeration date
05/02/2007
Last updated
11/24/2014
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