Individual
DR. PHILIP RODNEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
857 SHORE VIEW DR, COLUMBIA, SC 29212-8365
(803) 609-5216
Mailing address
857 SHORE VIEW DR, COLUMBIA, SC 29212-8365
(803) 609-5216
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2416
SC
1223G0001X
General Practice Dentistry
Primary
2416
SC
Other
Enumeration date
02/11/2008
Last updated
09/30/2022
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