Individual
BENITA S. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
617 WOODLAND ST, NASHVILLE, TN 37206-4211
(615) 256-2321
(615) 256-2329
Mailing address
617 WOODLAND ST, NASHVILLE, TN 37206-4211
(615) 299-5666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS7142
TN
Other
Enumeration date
11/30/2005
Last updated
09/27/2011
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