| Organization Name: | SCOTT JACKS, DDS, INC |
| NPI Number: | 1043414576 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY DAVID MINSKY (OWNER) |
| Mailing Address: | 20700 Avalon Blvd Suite 600 Carson |
| State: | CA US |
| Postal Code: | 907463701 |
| Phone Number: | 3102416175 |
| Fax Number: | 3232497565 |
| NPI Enumeration Date: | 06/11/2007 |
| NPI Last Update Date: | 09/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 31668 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | 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. |