Individual
FANNY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2601 10TH AVE N, SUITE 1000, PALM SPRINGS, FL 33461-3141
(561) 642-1008
(561) 802-3976
Mailing address
38754 STATE ROAD 80, BELLE GLADE, FL 33430-5615
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH23160
FL
Other
Enumeration date
09/25/2015
Last updated
09/25/2015
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