Jackson Pediatric Dentistry of Summerville

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

911 Issued in SC

Legal business name

JACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE

Practice address

405 West 4TH Street North
Summerville, SC 29483

Phone

(843) 376-3161

NPI assigned

Aug 9, 2018

Last updated

Aug 9, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Jackson, DDS

Title

Owner

Phone

(910) 620-7881

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1962981142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 BRANCH CREEK TRL",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294835338",
            "telephone_number": "910-620-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 WEST 4TH STREET NORTH",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "29483",
            "telephone_number": "843-376-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-620-7881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intrepid of the Sandhills, Inc. (Intrepid Palliative & Supportive Care)
• Prat Itharat, M.D.
• David West Ivey, DMD
• Jackson Davenport Vision Services , LLC (Jackson Davnport Vision Center)
• Jackson Davenport Vision, Inc.
• Ebony Louise Jackson
• Mandy Jackson
• Megan Kayla Jackson
• Nancy Pritchard Jackson, MPT
• Tammy Denise Jackson

• Pediatric Dentistry in Summerville, SC
• Providers in Summerville, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.