Provider Demographics
NPI:1235192469
Name:JACKSON, CRAIG W (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:JACKSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOSPITAL CENTER BLVD
Mailing Address - Street 2:HOSPITAL MEDICAL PAVILION, SUITE 102
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2738
Mailing Address - Country:US
Mailing Address - Phone:843-689-5500
Mailing Address - Fax:843-689-6600
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:HOSPITAL MEDICAL PAVILION, SUITE 102
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-689-5500
Practice Address - Fax:843-689-6600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice