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General NPI Number Information
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NPI Number | 1194928614
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Entity Type | Organization
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Legal Business Name | SCOTT JACKS, DDS, INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 4354 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6237
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Country | US
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Telephone | 323-564-2444
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Fax | 323-249-7565
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Provider Business Mailing Address
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Address Line | 4354 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6237
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Country | US
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Telephone | 323-564-2444
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Fax | 323-249-7565
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY DAVID MINSKY
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Credential | DDS
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Telephone | 323-564-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 31668
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License Number State | CA
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