Provider Demographics
NPI:1396863544
Name:JACKSON, FRANCINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCINE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2018
Mailing Address - Country:US
Mailing Address - Phone:562-591-4028
Mailing Address - Fax:562-591-5878
Practice Address - Street 1:1711 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2018
Practice Address - Country:US
Practice Address - Phone:562-591-4028
Practice Address - Fax:562-591-5878
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice