Individual
ALICIA RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
245 5TH AVE FL 3, NEW YORK, NY 10016-8728
(917) 747-6574
Mailing address
233 E JERICHO TPKE, HUNTINGTON STATION, NY 11746-7307
(631) 427-4327
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057371-1
NY
Other
Enumeration date
10/13/2014
Last updated
12/31/2020
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