Provider Demographics
NPI:1740651843
Name:JACKSON, ANDREW SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SCOTT
Last Name:JACKSON
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 1:101 RANWORTH LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4078
Mailing Address - Country:US
Mailing Address - Phone:601-850-4223
Mailing Address - Fax:
Practice Address - Street 1:1303 S PEARL ST
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-2200
Practice Address - Country:US
Practice Address - Phone:843-572-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice