Individual
MRS. WANDA KAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
510 E STONER AVE, #160, SHREVEPORT, LA 71101-4243
(318) 221-8411
(318) 841-4795
Mailing address
510 E STONER AVE, #160, SHREVEPORT, LA 71101-4243
(318) 221-8411
(318) 841-4795
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
376
LA
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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