Susanne Parkhurst Jackson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7143 Issued in NC

Practice address

121 S Estes Dr
Suite 205-a
Chapel Hill, NC 27514-2868

Phone

(919) 968-9874

Fax

(919) 969-8377

NPI assigned

Jan 16, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033260096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 N CIRCLE DR",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275163106",
            "telephone_number": "919-929-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 S ESTES DR",
            "address_2": "SUITE 205-A",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275142868",
            "telephone_number": "919-968-9874",
            "fax_number": "919-969-8377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SUSANNE",
        "middle_name": "PARKHURST",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER",
            "identifier": "902EF",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902EF",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Jackson, DDS
• Hannah Rachael Jackson
• Kimberly Dawn Jackson, MPT
• Leron C Jackson, MD, MPH
• Sharonda Latecha Jackson, PA-S
• Tate H Jackson, DDS, MS
• Victoria Brooke Jackson
• Diane Jacob, LCMHCA
• Jeeva Jacob, MD
• Ann Jacobi Brown, AGPCNP-BC

• General Practice Dentistry in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.