Individual
TAYLER YVETTE KEITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5140 JIMMY LEE SMITH PKWY, HIRAM, GA 30141-2745
(770) 439-1038
Mailing address
5140 JIMMY LEE SMITH PKWY, HIRAM, GA 30141-2745
(770) 439-1038
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122496
GA
1223G0001X
General Practice Dentistry
DEN1002033
DC
Other
Enumeration date
08/28/2019
Last updated
09/24/2021
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