Organization
JACKSON CLOVER ORTHODONTICS LLC
Active
Other names
Clover Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFRED MANWUEL JACKSON DDS (OWNER)
(352) 256-8164
Entity
Organization
Contact information
Practice address
1474 HIGHWAY 55 E STE 100, CLOVER, SC 29710-9218
(803) 653-6979
Mailing address
1474 HIGHWAY 55 E STE 100, CLOVER, SC 29710-9218
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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