Provider Demographics
NPI:1235757279
Name:HANIGOFSKY, JACKSON ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:ANDREW
Last Name:HANIGOFSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 SHADOWFAX WYND
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9254
Mailing Address - Country:US
Mailing Address - Phone:828-228-9697
Mailing Address - Fax:
Practice Address - Street 1:231 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2570
Practice Address - Country:US
Practice Address - Phone:828-322-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice