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General NPI Number Information
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NPI Number | 1447827167
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Entity Type | Organization
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Legal Business Name | CHRISTA L JACKSON DENTAL HYGIENIST, INC.
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 4508 SAINT CLAIR AVE
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City | STUDIO CITY
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State | CA
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Zip | 91604-1209
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Country | US
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Telephone | 818-269-8898
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Fax | 818-506-2595
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Provider Business Mailing Address
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Address Line | 4508 SAINT CLAIR AVE
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City | STUDIO CITY
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State | CA
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Zip | 91604-1209
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Country | US
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Telephone | 818-269-8898
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Fax | 818-506-2595
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHRISTA LYNN JACKSON
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Credential | RDHAP
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Telephone | 818-269-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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