# JACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962981142
- **Authorized official:** DR. JEFFREY JACKSON DDS (OWNER)
- **Authorized official phone:** (910) 620-7881

## Contact information

- **Practice address:** 405 WEST 4TH STREET NORTH, SUMMERVILLE, SC 29483
- **Practice address phone:** (843) 376-3161
- **Mailing address:** 303 BRANCH CREEK TRL, SUMMERVILLE, SC 29483-5338
- **Mailing address phone:** (910) 620-7881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 911 | SC | Yes |

## Other

- **Enumeration date:** 08/09/2018
- **Last updated:** 08/09/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZX8666 | — | SC |