OPHELIA FAYE JACKSON DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****21

License Status

NOT RENEWED

Business

First Name

OPHELIA

Middle

FAYE

Last Name

JACKSON

Suffix

DDS

Business Name

OPHELIA FAYE JACKSON DDS

Original Issue Date

09/13/2004

Effective Date

10/19/2016

Expiration Date

09/30/2018

City

NEW YORK

State

Zip

10011

County

NEW YORK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/31/2018