Individual
MS. MAGGIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH (BSDH/MASTER OF
Contact information
Practice address
4000 COAST GUARD BLVD., PORTSMOUTH, VA 23703
(757) 483-8596
(757) 483-8610
Mailing address
14 TOWNE SQUARE DRIVE, NEWPORT NEWS, VA 23607
(757) 247-3174
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402003432
VA
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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