OPHELIA FAYE JACKSON DDS - Dentist License in New York | # 019026369

OPHELIA FAYE JACKSON DDS

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019026369

License Status

NOT RENEWED

Business

N

First Name

OPHELIA

Middle

FAYE

Last Name

JACKSON

Suffix

DDS

Business Name

OPHELIA FAYE JACKSON DDS

Original Issue Date

04/15/2004

Effective Date

10/19/2016

Expiration Date

09/30/2018

State

NY

Ever Disciplined

N

LastModifiedDate

10/31/2018