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Organization
JACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE
Active
Organization
JACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY JACKSON DDS (OWNER)
(910) 620-7881
Entity
Organization
Contact information
Practice address
405 WEST 4TH STREET NORTH, SUMMERVILLE, SC 29483
(843) 376-3161
Mailing address
303 BRANCH CREEK TRL, SUMMERVILLE, SC 29483-5338
(910) 620-7881
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
911
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX8666
—
SC
Enumeration date
08/09/2018
Last updated
08/09/2018
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