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Organization
SCOTT JACKS DDS INC
Active
Organization
SCOTT JACKS DDS INC
Active
Other names
CHILDREN'S DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY DAVID MINSKY DDS (OWNER)
(323) 564-2444
Entity
Organization
Contact information
Practice address
4444 TWEEDY BLVD, SOUTH GATE, CA 90280-6304
(323) 564-2444
(564) 249-7565
Mailing address
4444 TWEEDY BLVD, SOUTH GATE, CA 90280-6304
(323) 564-2444
(564) 249-7565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
31668
AZ
1223E0200X
Endodontics
31668
CA
1223P0221X
Pediatric Dentistry
31668
CA
1223P0300X
Periodontics
31668
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
31668
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
31668
CA
Other
Enumeration date
09/20/2006
Last updated
09/23/2015
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