Desirae Jackson, CDA

NPI #1851581078 in Buffalo, New York

Provider Information

NPI Number: 1851581078
Entity Type: Individual
Name: Desirae Jackson, CDA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Assistant
Credential: CDA
Enumeration Date: Jul 25, 2007
Last Updated: Jul 25, 2007

Practice Location

Address: VA WNY HEALTHCARE SYSTEM
Address 2: 3495 BAILEY AVE
City: Buffalo
State: New York
ZIP Code: 14215-1311
Phone: (716) 862-8738

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Assistant	126800000X	Primary

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