Individual
DESIRAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDA
Contact information
Practice address
VA WNY HEALTHCARE SYSTEM, 3495 BAILEY AVE, BUFFALO, NY 14215-1311
(716) 862-8738
Mailing address
62 CROY AVE, BUFFALO, NY 14215-1311
(716) 862-8137
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
07/25/2007
Last updated
07/25/2007
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