Provider Demographics
NPI:1952736860
Name:JACKSON, LINDSEY JR (DN008579)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:DN008579
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CARL GRIFFIN DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1362
Mailing Address - Country:US
Mailing Address - Phone:912-651-2531
Mailing Address - Fax:912-651-2534
Practice Address - Street 1:191 CARL GRIFFIN DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1362
Practice Address - Country:US
Practice Address - Phone:912-651-2531
Practice Address - Fax:912-651-2534
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist