| NPI | 1578707204 |
|---|---|
| Professional Name | ANDREA D JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: DC DN4077) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD 08111) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-04-24 |