Provider Demographics
NPI:1568665412
Name:JACKSON, NATALIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:S
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 1:2633 NAPOLEON AVE STE 820
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7413
Mailing Address - Country:US
Mailing Address - Phone:504-895-3580
Mailing Address - Fax:504-891-1449
Practice Address - Street 1:2633 NAPOLEON AVE STE 820
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7413
Practice Address - Country:US
Practice Address - Phone:504-895-3580
Practice Address - Fax:504-891-1449
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice