Provider Demographics
NPI:1801202619
Name:JACKSON-TAYLOR, YOLANDA JUANITHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:JUANITHA
Last Name:JACKSON-TAYLOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:JUANITHA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:407 W ELDORADO PKWY STE 355
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3010 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-2723
Practice Address - Country:US
Practice Address - Phone:972-444-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3763-14122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist