Provider Demographics
NPI:1215033394
Name:BROWN-JACKSON, JENNIFER L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BROWN-JACKSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-1100
Mailing Address - Country:US
Mailing Address - Phone:352-493-0099
Mailing Address - Fax:352-493-9031
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1100
Practice Address - Country:US
Practice Address - Phone:352-493-0099
Practice Address - Fax:352-493-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist