Provider Demographics
NPI:1346973310
Name:JACKSON, MEGAN KARST (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KARST
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:RENEE
Other - Last Name:KARST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:26 AUDUBON PL
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1907
Mailing Address - Country:US
Mailing Address - Phone:334-315-1232
Mailing Address - Fax:
Practice Address - Street 1:5710 KATHERINE HANKINS DR
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-1918
Practice Address - Country:US
Practice Address - Phone:251-653-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.7044-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice