JACKSON PEDIATRIC DENTISTRY LLC (NPI# 1144679507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144679507 |
| Entity Type | Organization |
| Organization Name | JACKSON PEDIATRIC DENTISTRY LLC |
| Practice Address |
1236 Ebenezer Rd Suite 110 Rock Hill SC 29732-3390 |
| Mailing Address |
1686 Highway 160 W Fort Mill SC 29708-8024 |
| Practice Telephone | 8033247540 |
| Practice Fax Number | 8033244128 |
| Mailing Telephone | 8035482333 |
| Mailing Fax Number | 8035482703 |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2016-08-03 |
| Authorized Official Name | DR. STEPHANIE LYNN JACKSON (PEDIATRIC DENTIST) |
| Authorized Official Telephone | 9194124199 |
| Authorized Official Credential | DDS, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
1236 EBENEZER RD SUITE 110 |
| City | ROCK HILL |
| State | SC |
| Zip Code | 29732-3390 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740288844 | Charles Harmon Crawford Jr. | Dentist | 1236 Ebenezer Rd, Ste 110, Rock Hill, SC 29732-2300 | 2005-07-12 |
| 1083054795 | Lauren Paul Dean | Dentist | 1236 Ebenezer Rd, Rock Hill, SC 29732-3390 | 2013-06-26 |
| 1912288226 | Alexander Joseph Culp | Dentist | 1236 Ebenezer Rd, Suite 100, Rock Hill, SC 29732-3390 | 2011-08-31 |
| 1417958513 | Maria Elizabet Cardenas | Nurse Practitioner | 1236 Ebenezer Rd, Rock Hill, SC 29732-2300 | 2005-08-10 |
| 1083612170 | Charles H. Crawford, Jr Dmd | Dentist | 1236 Ebenezer Rd, Suite 110, Rock Hill, SC 29732-2300 | 2005-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023659471 | Jessie M. Armstrong | Counselor | 199 S Herlong Avenue, Rock Hill, SC 29732 | 2019-10-07 |
| 1215407861 | Alicia Johnson | Occupational Therapist | 2025 Ebenezer Rd Suite H, Rock Hill, SC 29732 | 2018-11-27 |
| 1346716909 | Leslie Marie Metzler | Nurse Practitioner | 125 Amendment Ave, Rock Hill, SC 29732 | 2018-10-22 |
| 1356824668 | Laurie E Grove | Counselor | 508 Bethel Street, Clover, SC 29732 | 2018-09-12 |
| 1366924441 | Chinyere Gill-smith | Occupational Therapist | 2390 127 Murrah Drive, Rock Hill, SC 29732 | 2018-09-05 |
| 1053825513 | Community Medicine Foundation Inc | Clinic/Center | 205 Piedmont Blvd. Suite 100, Catawba Community Mental Health Services York Adult Ser, Rock Hill, SC 29732 | 2017-11-20 |
| 1952824906 | Miriam George-norman | Occupational Therapist | 831 Mcdow Drive, Rock Hill, SC 29732 | 2017-07-21 |
| 1255854550 | Courtney Costa | Counselor | 199 S. Herlong Avenue, Rock Hill, NC 29732 | 2017-07-19 |
| 1861913022 | Drs Misiek, Farrell, Farrell, Nale, Cook, Kapitan, Mohamed & Franco Pa | Oral & Maxillofacial Surgery | 1761 Ebenezer Road, Rock Hill, SC 29732 | 2017-06-28 |
| 1396275806 | Chrysalis Autism Center, Inc | Assistant Behavior Analyst | 1547 Cherry Rd, Rock Hill, SC 29732 | 2017-06-16 |
| Find all providers in zip 29732 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770918351 | Pedo Carolina, Inc. | Dentist | 2460 India Hook Rd Ste 106, Rock Hill, SC 29732-3530 | 2013-09-13 |
| 1740288844 | Charles Harmon Crawford Jr. | Dentist | 1236 Ebenezer Rd, Ste 110, Rock Hill, SC 29732-2300 | 2005-07-12 |
| 1023012705 | Michele Boyne | Dentist | 1562 Constitution Blvd, Ste 102, Rock Hill, SC 29732-3004 | 2005-06-09 |
| 1326264938 | J. Michele Boyne, D.m.d. LLC | Dentist | 1562 Constitution Blvd, Suite 102, Rock Hill, SC 29732-3004 | 2007-04-18 |
| 1083612170 | Charles H. Crawford, Jr Dmd | Dentist | 1236 Ebenezer Rd, Suite 110, Rock Hill, SC 29732-2300 | 2005-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598493 | Pleasant Mill Pediatric Dentistry | Dentist | 1690 Highway 160 W Ste A, Fort Mill, SC 29708-8024 | 2020-11-02 |
| 1124635495 | Destination Dental of Duncan LLC | Dentist | 155 Deacon Tiller Ct, Duncan, SC 29334-8880 | 2020-09-30 |
| 1487267365 | Cp Dentistry, LLC | Dentist | 9919 Dorchester Road, Summerville, SC 29485 | 2020-08-28 |
| 1811519507 | Stephanie Silva Dmd, LLC | Dentist | 133 Allen Court, North Augusta, SC 29860 | 2020-05-15 |
| 1235776568 | Tribe Dental LLC | Dentist | 11 Magnolia Cove Dr, Simpsonville, SC 29680 | 2019-12-05 |
| 1457994196 | Sfd Mt. Pleasant LLC | Dentist | 3102 N Highway 17, Mount Pleasant, SC 29466-6925 | 2019-10-25 |
| 1073162053 | Southern Charm Pediatric Dentistry | Dentist | 2021 Bridgemill Rd., Suite 108, Indian Land, SC 29707-2817 | 2019-09-11 |
| 1649825969 | Oak Landing Pediatric Dentistry, LLC | Dentist | 2001 2nd Ave Ste 102, Summerville, SC 29486-7887 | 2019-08-04 |
| 1851858013 | The Tot Spot of South Carolina | Dentist | 1334 S. Hwy 14, Simpsonville, SC 29681 | 2019-02-25 |
| 1588130942 | Dentistry for Children of South Carolina PC | Dentist | 1701 Beaucastel Rd Ste A, Mount Pleasant, SC 29464-3685 | 2018-10-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JACKSON PEDIATRIC DENTISTRY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.