Organization
JACKSON SMILE STUDIO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP RODNEY JACKSON D.M.D. (PRESIDENT)
(803) 750-0044
Entity
Organization
Contact information
Practice address
3790 FERNANDINA RD, SUITE 201, COLUMBIA, SC 29210-3864
(803) 750-0044
(803) 750-0021
Mailing address
3790 FERNANDINA RD, SUITE 201, COLUMBIA, SC 29210-3864
(803) 750-0044
(803) 750-0021
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2416
SC
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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