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Organization
JACKSON PEDIATRIC DENTISTRY LLC
Active
Organization
JACKSON PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE LYNN JACKSON DDS, MS (PEDIATRIC DENTIST)
(919) 412-4199
Entity
Organization
Contact information
Practice address
1236 EBENEZER RD, SUITE 110, ROCK HILL, SC 29732-3390
(803) 324-7540
(803) 324-4128
Mailing address
1686 HIGHWAY 160 W, FORT MILL, SC 29708-8024
(803) 548-2333
(803) 548-2703
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/07/2016
Last updated
08/03/2016
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