Individual
SCOTT CHRISTIAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5180 PARK AVE STE 210, MEMPHIS, TN 38119-3530
(901) 763-0850
Mailing address
17649 ROCKWOOD ARBOR DR, EUREKA, MO 63025-4035
(636) 236-3714
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12245
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2022
Last updated
02/06/2024
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