Natalie Ann Jackson

Primary specialty

DentistTaxonomy code 122300000X

License

4722 Issued in AR

Practice address

2603 W Pleasant Grove Rd Ste 111
Rogers, AR 72758-8514

Phone

(479) 282-1023

NPI assigned

Apr 19, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• River Dental Rogers South, PLLC

  • General Practice Dentistry
  • Rogers, AR
  • NPI 1669035770
  NPD (past)

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1104513134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 HAZEL CT",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727620861",
            "telephone_number": "479-721-1048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 W PLEASANT GROVE RD STE 111",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588514",
            "telephone_number": "479-282-1023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 S New Ballas Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631418221",
            "country_code": "US",
            "telephone_number": "314-251-5775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NATALIE",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2023022968",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Alexander Irwin, M.D.
• Gary Ivey, PD
• Chrissy Jackson, QBHP
• Luke W Jackson, LPC
• Mynhan Huynh Jackson, MD
• Sandra Dee Jackson
• Svetlana Jackson, LAC
• Syndey Jackson
• Dominic Amadeo Jacobelli, MD
• Tabitha Jaggers, PA

• All providers in Rogers, AR
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.