OPHELIA FAYE JACKSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST

License Number

019026369

License Status

NOT RENEWED

Business

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

City

NEW YORK

State

Zip

10011

County

NEW YORK

Ever Disciplined

LastModifiedDate

10/31/2018