Provider Demographics
NPI:1336712496
Name:SEAGROVES, JACKSON T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:T
Last Name:SEAGROVES
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 1:50201 GOVERNORS DRIVE GOVERNORS ENDODONTICS
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-537-8461
Mailing Address - Fax:919-537-8461
Practice Address - Street 1:50201 GOVERNORS DRIVE GOVERNORS ENDODONTICS
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-537-8461
Practice Address - Fax:919-537-8461
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124121223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist