| NPI | 1801202619 |
|---|---|
| Former Name | YOLANDA JUANITHA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3763-14) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3763-14) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2023-11-06 |