Jackson-Williams, Phyllis Renee

Jackson-Williams, Phyllis Renee is an sole proprietor health care provider with primary practice located at 11312 Jefferson Hwy , River Ridge LA 70123-1709. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Jackson-Williams, Phyllis Renee can be contacted via phone (504) 463-5999.

Contact Information

Primary practice address
11312 Jefferson Hwy River Ridge LA 70123-1709
Fax: (504) 463-5990
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 5004 Louisiana

Profile Details

NPI number 1912050832
LBN Legal business name Jackson-Williams, Phyllis Renee
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 22nd, 2007
Last updated Mar 23rd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912050832 NPPES
Louisiana MEDICAID 1850047

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