Provider Demographics
NPI:1871801399
Name:JACKSON, TIFFANY JAN'NELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:JAN'NELLE
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 1:2550 WINDMILL LN STE 145
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5500
Mailing Address - Country:US
Mailing Address - Phone:702-331-4848
Mailing Address - Fax:702-331-4448
Practice Address - Street 1:2550 WINDMILL LN STE 145
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5500
Practice Address - Country:US
Practice Address - Phone:702-331-4848
Practice Address - Fax:702-331-4448
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV60801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice