Active NPI
Taylor Nicole Jackson, DDS
- Pediatric Dentistry
- Chicago, IL
National Provider Identifier
1043943939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 019.036136
- Practice address
- 6307 S Stewart Ave
Chicago, IL 60621-3116 - Phone
- (773) 962-3976
- NPI assigned
- Jul 7, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 019.036136 | IL | Primary |
Addresses
Primary practice location
6307 S Stewart Ave
Chicago, IL 60621-3116
Mailing address
820 S Wood St Ste 100
Chicago, IL 60612-4325
Phone (312) 996-2933
Other practice location 1
3290 Executive Dr Unit 100
Joliet, IL 60431-8465
Phone (815) 729-2277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.036136 | IL | MD | Pediatric Dentist |
Interoperability endpoints
- tjackson135743@uihealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761004800000",
"number": "1043943939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 S WOOD ST STE 100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606124325",
"telephone_number": "312-996-2933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6307 S STEWART AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606213116",
"telephone_number": "773-962-3976"
}
],
"practiceLocations": [
{
"address_1": "3290 Executive Dr Unit 100",
"address_purpose": "LOCATION",
"city": "Joliet",
"state": "IL",
"postal_code": "604318465",
"country_code": "US",
"telephone_number": "815-729-2277",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "TAYLOR",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-07",
"last_updated": "2025-10-21",
"certification_date": "2025-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "019.036136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.