Jackson Creek Dental Care, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JACKSON CREEK DENTAL CARE, P.C.

Doing business as

Jackson Creek Dental Care

Practice address

15854 Jackson Creek Pkwy
Suite 140
Monument, CO 80132-8663

Phone

(719) 302-2200

Fax

(216) 584-1360

NPI assigned

Aug 18, 2008

Last updated

Mar 20, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

DENTALONE PARTNERS, INCAs reported in NPPES

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

Authorized official

Name

Rachel Nittinger

Title

Manager Credentialing3

Phone

(972) 755-0816

Specialties & licenses 7

Addresses

Other names 1

• Jackson Creek Dental Care Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Guerin Dwyer, DDS

  • General Practice Dentistry
  • Monument, CO
  • NPI 1790933455
  NPD (past)
• Amanda Rachelle Miller, D.D.S.

  • Dentist
  • Parker, CO
  • NPI 1164672002
  NPD (past)

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521504000000",
    "number": "1013163351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 DALLAS PKWY STE 400",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750247111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15854 JACKSON CREEK PKWY",
            "address_2": "SUITE 140",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801328663",
            "telephone_number": "719-302-2200",
            "fax_number": "216-584-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CREEK DENTAL CARE, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTALONE PARTNERS, INC",
        "enumeration_date": "2008-08-18",
        "last_updated": "2018-03-20",
        "status": "A",
        "authorized_official_last_name": "NITTINGER",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "MANAGER CREDENTIALING3",
        "authorized_official_telephone_number": "972-755-0816"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Creek Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marie Elizabeth Hynek, OTD, OTR/L
• Innova Recovery Services, LLC
• J. Blair Cano, PSYD, MSCP (Cano Consulting)
• Dylan Alexander Jachimek
• Jackson Creek Assisted Living, LLC (Jackson Creek Senior Living)
• Catherine Jackson
• Jenna Jackson, LPC
• Kacey Marie Jacques, PT
• Warren Jaeger, MD
• Jah Wellness PLLC

• General Practice Dentistry in Monument, CO
• Providers in Monument, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.