Individual
RICHARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2759 WHISKEY RD, AIKEN, SC 29803-6197
(803) 649-3411
Mailing address
2759 WHISKEY RD, AIKEN, SC 29803-6197
(803) 649-3411
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3492
SC
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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