Individual
AMIRAH DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
300 N GRACE ST, ROCKY MOUNT, NC 27804-5345
(252) 210-9856
(888) 736-9806
Mailing address
300 N GRACE ST, ROCKY MOUNT, NC 27804-5345
(252) 210-9856
(888) 736-9806
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14570
NC
1223G0001X
General Practice Dentistry
Primary
6902
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2869027
—
LA
Enumeration date
03/15/2017
Last updated
02/13/2026
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