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NPI Code Detail

MEDICARE: SCOTT JACKS, DDS, INC

MEDICARE: SCOTT JACKS, DDS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry31668CA
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry31668CA
3122300000XDentist31668CA

General Provider Information

NPI Number : 1871632745
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCOTT JACKS, DDS, INC
Provider Business Mailing Address
First Line : 2144 S BRISTOL ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-5123
Country : US
Telephone Number : 714-619-6280
Fax Number : 323-249-7565
Provider Business Practice Location Address
First Line : 2144 S BRISTOL ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-5123
Country : US
Telephone Number : 714-619-6280
Fax Number : 323-249-7565
Authorized Official
Title or Position : OWNER
Name : DR. JERRY DAVID MINSKY
Credential : DDS
Telephone Number : 323-564-2444
Provider Enumeration Date : 02/06/2007
Last Update Date : 09/23/2015

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