Provider Demographics
NPI:1063689586
Name:CRAIG W JACKSON DDS
Entity Type:Organization
Organization Name:CRAIG W JACKSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-689-5500
Mailing Address - Street 1:25 HOSPITAL CENTER BLVD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2735
Mailing Address - Country:US
Mailing Address - Phone:843-689-5500
Mailing Address - Fax:843-689-6600
Practice Address - Street 1:25 HOSPITAL CENTER BLVD SUITE 102
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2735
Practice Address - Country:US
Practice Address - Phone:843-689-5500
Practice Address - Fax:843-689-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty