Individual
ANTHONY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9541 JEFFERSON HWY, RIVER RIDGE, LA 70123-2507
(504) 738-1567
Mailing address
1101 RURAL ST, RIVER RIDGE, LA 70123-2745
(504) 737-9416
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4079
LA
Other
Enumeration date
03/04/2007
Last updated
07/08/2007
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