Individual
DR. JACKIE DALE NANNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
188 NICARAGUA ST, BEAUFORT, SC 29902-7552
(843) 228-3500
Mailing address
188 NICARAGUA ST, BEAUFORT, SC 29902-7552
(843) 228-3500
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DN 8903
FL
Other
Enumeration date
08/24/2005
Last updated
09/14/2007
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