Individual
DR. CARL JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
121 WILDEWOOD PARK DR, COLUMBIA, SC 29223-4300
(803) 736-5300
(803) 736-1422
Mailing address
121 WILDEWOOD PARK DR, COLUMBIA, SC 29223-4300
(803) 736-5300
(803) 736-1422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12010844A
IN
1223G0001X
General Practice Dentistry
Primary
7045
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200865730A
—
IN
05
—
PENDING
—
SC
Enumeration date
11/02/2006
Last updated
08/20/2024
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