Jackson Van, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12050 Issued in OR

Practice address

20140 McLoughlin Blvd
Gladstone, OR 97027-2604

Phone

(971) 404-1374

NPI assigned

Jul 22, 2024

Last updated

Nov 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1083442164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10952 SE LENORE ST",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970868789",
            "telephone_number": "503-475-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20140 MCLOUGHLIN BLVD",
            "city": "GLADSTONE",
            "state": "OR",
            "postal_code": "970272604",
            "telephone_number": "971-404-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "JACKSON",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D12050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montana Thorner, PC
• Tracy Todd, LMT
• Stephanie Lynn Tolonen, DC MS CCSP
• Savannah Torkelsen
• Maggie Truelove
• Kora Vanek, RN
• Elizabeth Varner
• Brad Marshal Vollmer, D.C.
• Danny Vu
• Walgreen Co (Walgreens #13727)

• General Practice Dentistry in Gladstone, OR
• Providers in Gladstone, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.