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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