Christopher R Jackson

Primary specialty

DentistTaxonomy code 122300000X

License

36092 Issued in TX

Practice address

3930 Tanglewood LN
Odessa, TX 79762-7165

Phone

(432) 366-0896

NPI assigned

Jul 3, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• TX HMO D-SNP
• NM HMO C-SNP

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737158400000",
    "number": "1003478629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 W WALL ST",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797016525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 TANGLEWOOD LN",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627165",
            "telephone_number": "432-366-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-03",
        "last_updated": "2025-01-18",
        "certification_date": "2025-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5055",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "36092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J a Mayans MD PA
• J&B Senior and Disabled Services
• Ali Jabur, MD
• Razzak Jabur, M.D.
• Justin Jackman, OD
• Gary Chase Jackson, O.D.
• Jean Petrilla Jackson, MA, LPC
• Rawnak Jahan
• Madhuri Jakkam Setty, MD
• Ameen Mohammad Jamali, M.D.

• Dentist in Odessa, TX
• Providers in Odessa, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.