Jackson Creek Dental

Primary specialty

DentistTaxonomy code 122300000X

License

12010765A Issued in IN

Legal business name

JACKSON CREEK DENTAL

Practice address

1124 S College Mall Rd
Bloomington, IN 47401-6178

Phone

(812) 336-5525

Fax

(812) 322-5520

NPI assigned

May 8, 2013

Organization subpart

No

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

Authorized official

Name

Ryan D Tschetter, D.D.S.NPI 1457431629

Title

Dentist

Phone

(812) 336-5525

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan David Tschetter, DDS

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1457431629
  NPD (past) Authorized official
• Lauren R Hoye, DDS

  • Dentist
  • Bloomington, IN
  • NPI 1497321665
  NPD (past)
• Whitney R Waldrup Marsh, DENTIST

  • Dentist
  • Bloomington, IN
  • NPI 1316424088
  NPD (past)

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1114362803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016178",
            "telephone_number": "812-336-5525",
            "fax_number": "812-322-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016178",
            "telephone_number": "812-336-5525",
            "fax_number": "812-322-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "TSCHETTER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "812-336-5525",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010765A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iu Health Medical Group, LLC
• Morgan Ives-Glasgow, LMHCA
• J Keith Roberts DDS LLC
• J M C L Inc
• Samantha Jablonsky, RBT
• Jackson Creek Dental
• Brianne Jackson
• Emma Carol Jackson, PA-C
• Jeffrey L Jackson, MD
• Julia Jackson, RBT

• Dentist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.