Active NPI
William Jackson
- Dentist
- Madeira, OH
National Provider Identifier
1063717049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30015160
- Practice address
- 7113 Miami Ave
Madeira, OH 45243-2616 - Phone
- (513) 561-5318
- Fax
- (513) 561-1120
- NPI assigned
- Jan 21, 2011
- Last updated
- Jan 21, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 30015160 | OH | Primary |
Addresses
Primary practice location
7113 Miami Ave
Madeira, OH 45243-2616
Mailing address
7113 Miami Ave
Madeira, OH 45243-2616
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 |
|---|---|---|---|
| 30015160 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. William G. Jackson Jr. DDS Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Cincinnati, OH
- NPI 1033214846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1063717049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7113 MIAMI AVE",
"city": "MADEIRA",
"state": "OH",
"postal_code": "452432616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7113 MIAMI AVE",
"city": "MADEIRA",
"state": "OH",
"postal_code": "452432616",
"telephone_number": "513-561-5318",
"fax_number": "513-561-1120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-21",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30015160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madeira, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.