Individual
JANET JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4323 HILL ST, COLUMBIA, SC 29207-6022
(760) 111-1111
Mailing address
4323 HILL ST, COLUMBIA, SC 29207-6022
(803) 724-2328
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
NONE
—
Enumeration date
01/03/2019
Last updated
06/24/2022
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