NPIMap

Organization Active NPI

Cecily L. Jackson, DDS, P.C.

Doing business as Jackson Pediatric Dentistry

  • Pediatric Dentistry
  • Lubbock, TX
National Provider Identifier
1053667451
Registry record updated Aug 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
24654 Issued in TX
Legal business name
CECILY L. JACKSON, DDS, P.C.
Doing business as
Jackson Pediatric Dentistry
Practice address
3233 63Rd St
Suite a
Lubbock, TX 79413-5742
Phone
(806) 789-9870
NPI assigned
Aug 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2012

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

Authorized official

Name
Dr. Cecily Lynn Jackson, DDSNPI 1952537045
Title
Registered Agent/Director
Phone
(806) 789-9870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 24654 TX Primary

Addresses

Primary practice location

3233 63Rd St
Suite a
Lubbock, TX 79413-5742

Mailing address

21 W Lakeshore Dr
Ransom Canyon, TX 79366-2517

Other names 1

  • Jackson Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

3233 63rd St
Ste A
Lubbock, TX 79413
Phone (806) 577-8600

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": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343952000000",
    "number": "1053667451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 W LAKESHORE DR",
            "city": "RANSOM CANYON",
            "state": "TX",
            "postal_code": "793662517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3233 63RD ST",
            "address_2": "SUITE A",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794135742",
            "telephone_number": "806-789-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CECILY L. JACKSON, DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2012-08-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CECILY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "REGISTERED AGENT/DIRECTOR",
        "authorized_official_telephone_number": "806-789-9870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "24654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; 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.