Provider Demographics
NPI:1285942243
Name:JACKSON, CHRISTA LYNN (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 SAINT CLAIR AVENUE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:818-269-8898
Mailing Address - Fax:818-506-2595
Practice Address - Street 1:4508 SAINT CLAIR AVENUE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:818-269-8898
Practice Address - Fax:818-506-2595
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP314124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist