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1047 Harriman Pl Ste. B San Bernardino CA 92408-4203 | |
| (909) 796-6700 | |
| (909) 796-6779 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1047 Harriman Pl, San Bernardino, California |
| Authorized Official Name and Position | Tanisha A Jackson (OWNER DDS) |
| Authorized Official Contact | 9097966700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2860 Michelle 2nd Floor Irvine CA 92606-1009 Ph: (714) 508-3600 | 1047 Harriman Pl Ste. B San Bernardino CA 92408-4203 Ph: (909) 796-6700 |
| NPI Number | 1841396637 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 05/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841396637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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