Marylyn Jackson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-017207 Issued in IL

Practice address

2555 Lincoln Hwy
Suite 113
Olympia Fields, IL 60461-1936

Phone

(708) 679-0668

NPI assigned

Mar 7, 2013

Last updated

Mar 7, 2013By the provider in NPPES

Sex

Female

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

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362614400000",
    "number": "1023359510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 LINCOLN HWY",
            "address_2": "SUITE 113",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611936",
            "telephone_number": "708-679-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 LINCOLN HWY",
            "address_2": "SUITE 113",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611936",
            "telephone_number": "708-679-0668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARYLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-07",
        "last_updated": "2013-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-017207",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-017207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jab Counseling and Consulting Services, LLC
• Saadia Jabbar, MD
• Reenee Jackson-Hill, ABA
• Joanna M Jackson, D.O.
• Laquanta Jackson
• Quiana Monique Jackson, APN
• Whittney L Jackson
• Pankaj Jain, M.D.
• James H Camino DDS LTD
• Nanette Marie James Patrick, M.D.

• General Practice Dentistry in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.