Provider Demographics
NPI:1609967553
Name:WHISNANT, JACKSON CAMERON III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:CAMERON
Last Name:WHISNANT
Suffix:III
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 1:2088B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1425
Mailing Address - Country:US
Mailing Address - Phone:864-582-4441
Mailing Address - Fax:
Practice Address - Street 1:2088B E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1425
Practice Address - Country:US
Practice Address - Phone:864-582-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice