R. Corey Jackson DDS, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8279 Issued in TN

Legal business name

R. COREY JACKSON DDS, LLC

Practice address

2365 N Mount Juliet Rd
Mt Juliet, TN 37122-3038

Phone

(615) 754-5840

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Corey Jackson, D.D.S.NPI 1548281017

Title

Managing Member

Phone

(615) 754-5840

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronald Corey Jackson, D.D.S.

  • General Practice Dentistry
  • Mt Juliet, TN
  • NPI 1548281017
  NPD (past) Authorized official

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043306467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 GRANDVIEW DR",
            "city": "OLD HICKORY",
            "state": "TN",
            "postal_code": "371381645",
            "telephone_number": "615-758-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 N MOUNT JULIET RD",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371223038",
            "telephone_number": "615-754-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. COREY JACKSON DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "COREY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "615-754-5840",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Mt Juliet, TN
• Providers in Mt Juliet, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.