| Jackson Pediatric Dentistry Of Summerville | |
|
405 West 4th Street North Summerville SC 29483 | |
| (843) 376-3161 | |
| Not Available |
| Full Name | Jackson Pediatric Dentistry Of Summerville |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 405 West 4th Street North, Summerville, South Carolina |
| Authorized Official Name and Position | Jeffrey Jackson (OWNER) |
| Authorized Official Contact | 9106207881 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Pediatric Dentistry Of Summerville 303 Branch Creek Trl Summerville SC 29483-5338 Ph: (910) 620-7881 | Jackson Pediatric Dentistry Of Summerville 405 West 4th Street North Summerville SC 29483 Ph: (843) 376-3161 |
| NPI Number | 1962981142 |
|---|---|
| Provider Enumeration Date | 08/09/2018 |
| Last Update Date | 08/09/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962981142 | NPI | - | NPPES |
| ZX8666 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 911 (South Carolina) | Primary |
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