Provider Demographics
NPI:1952537045
Name:JACKSON, CECILY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECILY
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:3233 63RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5742
Mailing Address - Country:US
Mailing Address - Phone:806-368-8856
Mailing Address - Fax:806-368-7859
Practice Address - Street 1:3233 63RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5742
Practice Address - Country:US
Practice Address - Phone:806-368-8856
Practice Address - Fax:806-368-7859
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2012-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX246541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry