Eric Jackson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026703 Issued in IL

Practice address

2033 Ogden Ave
Downers Grove, IL 60515-2601

Phone

(630) 963-6750

Fax

(630) 963-6761

NPI assigned

Apr 6, 2007

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 28, 2017 through Dec 28, 2027

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.

• Oral Healthcare Professionals

  • General Practice Dentistry
  • Downers Grove, IL
  • NPI 1134437262
  NPD (past) Authorized official

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1241481600000",
    "number": "1104949171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 OGDEN AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152601",
            "telephone_number": "630-963-6750",
            "fax_number": "630-963-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 OGDEN AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605152601",
            "telephone_number": "630-963-6750",
            "fax_number": "630-963-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ERIC",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2009-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Joseph Izewski
• J & E Counseling NFP
• J G Dentistry, S. C.
• J Hart & Associates
• Jenna Jablonski
• Kendal'Spirit Jackson, LPC
• Shelby Ellis Jackson, DMD
• Kathleen Callaghan Jacob, L.C.S.W
• Laura L Jacobs, RDH
• Mark M Jacquot, O.D.

• General Practice Dentistry in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.