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General NPI Number Information
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NPI Number | 1063231421
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Entity Type | Individual
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Provider Name | LAUREN CHRISTINE JACKSON DMD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 4950 W SAHARA AVE STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89146-3462
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Country | US
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Telephone | 702-680-1525
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Fax | 702-765-4398
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Provider Business Mailing Address
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Address Line | 6755 W ARBY AVE APT 338
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City | LAS VEGAS
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State | NV
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Zip | 89118-4763
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Country | US
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Telephone | 773-988-0098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8115
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License Number State | NV
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