NPIMap

Organization Active NPI

Scott Jacks, DDS, Inc

Doing business as Children's Dental Group

  • Dentist
  • Carson, CA
National Provider Identifier
1043414576
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
31668 Issued in CA
Legal business name
SCOTT JACKS, DDS, INC
Doing business as
Children's Dental Group
Practice address
20700 Avalon Blvd
Suite 600
Carson, CA 90746-3701
Phone
(310) 241-6175
Fax
(323) 249-7565
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

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

Authorized official

Name
Dr. Jerry David Minsky, DENTIST
Title
Owner
Phone
(323) 564-2444

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 31668 CA Primary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 31668 CA
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 31668 CA

Addresses

Primary practice location

20700 Avalon Blvd
Suite 600
Carson, CA 90746-3701

Mailing address

20700 Avalon Blvd
Suite 600
Carson, CA 90746-3701
Phone (310) 241-6175

Other names 1

  • CHILDREN'S DENTAL GROUP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Dental Group10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1043414576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20700 AVALON BLVD",
            "address_2": "SUITE 600",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463701",
            "telephone_number": "310-241-6175",
            "fax_number": "323-249-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20700 AVALON BLVD",
            "address_2": "SUITE 600",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907463701",
            "telephone_number": "310-241-6175",
            "fax_number": "323-249-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT JACKS, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "MINSKY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-564-2444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DENTIST"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "31668",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "31668",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "31668",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHILDREN'S DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.