National Provider Identifier
Desirae Jackson, CDA
Desirae Jackson, CDA is listed in the NPPES registry with a primary specialty of Dental Assistant in Buffalo, NY and a listed phone number of (716) 862-8738.
Profile Overview
- NPI
- 1851581078
- Provider Type
- Individual
- Primary Specialty
- Dental Assistant
- Enumeration Date
- July 25, 2007
- Last Updated
- July 25, 2007
Practice Location
- Va Wny Healthcare System
- 3495 Bailey Ave
- Buffalo, NY 14215-1311
Phone: (716) 862-8738
Mailing Address
- 62 Croy Ave
- Buffalo, NY 14215-1311
Specialties
- Dental Assistant (126800000X)
Full Record
- NPI
- 1851581078
- Entity Type
- Individual
- Last Name
- Jackson
- First Name
- Desirae
- Credential
- CDA
- Mailing Street Address
- 62 Croy Ave
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14215-1311
- Mailing Country
- US
- Mailing Phone
- (716) 862-8137
- Practice Street Address
- Va Wny Healthcare System
- Practice Address Line 2
- 3495 Bailey Ave
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14215-1311
- Practice Country
- US
- Practice Phone
- (716) 862-8738
- Enumeration Date
- July 25, 2007
- Last Updated
- July 25, 2007
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Dental Assistant (126800000X)