Provider Demographics
NPI:1568534782
Name:MCGILL, JACK M JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:MCGILL
Suffix:JR
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 1:65 SAMS POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907
Mailing Address - Country:US
Mailing Address - Phone:843-525-6866
Mailing Address - Fax:
Practice Address - Street 1:65 SAMS POINT ROAD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907
Practice Address - Country:US
Practice Address - Phone:843-525-6866
Practice Address - Fax:843-525-6290
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC19501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice