# JACKSON SMILE STUDIO - SDA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Smile Studio
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548738636
- **Authorized official:** MRS. JENNI TOMLINSON (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (803) 678-9999

## Contact information

- **Practice address:** 3790 FERNANDINA RD STE 201, COLUMBIA, SC 29210-3864
- **Practice address phone:** (803) 678-9999
- **Practice address fax:** (803) 750-0021
- **Mailing address:** 225 TOWNPARK DR NW STE 100, KENNESAW, GA 30144-5885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/06/2018
- **Last updated:** 10/09/2023