Provider Demographics
NPI:1063231421
Name:JACKSON, LAUREN CHRISTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6755 W ARBY AVE APT 338
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4763
Mailing Address - Country:US
Mailing Address - Phone:773-988-0098
Mailing Address - Fax:
Practice Address - Street 1:4950 W SAHARA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3462
Practice Address - Country:US
Practice Address - Phone:702-680-1525
Practice Address - Fax:702-765-4398
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist