Individual
DR. PHYLLIS RENEE JACKSON-WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11312 JEFFERSON HWY, RIVER RIDGE, LA 70123-1709
(504) 463-5999
(504) 463-5990
Mailing address
11312 JEFFERSON HWY, RIVER RIDGE, LA 70123-1709
(504) 463-5999
(504) 463-5990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5004
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1850047
—
LA
Enumeration date
01/22/2007
Last updated
03/23/2012
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