Active NPI
Sean Jackson, RDH
- Dental Hygienist
- Detroit, MI
National Provider Identifier
1114368917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902014962
- Practice address
- 111 W 7 Mile Rd
Detroit, MI 48203-1968 - Phone
- (313) 369-2600
- Fax
- (313) 369-2477
- NPI assigned
- Jul 10, 2013
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902014962 | MI | Primary |
Addresses
Primary practice location
111 W 7 Mile Rd
Detroit, MI 48203-1968
Mailing address
111 W 7 Mile Rd
Detroit, MI 48203-1968
Phone (313) 369-2600
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 |
|---|---|---|---|
| 2902014962 | MI | MD | Dental Hygienist |
Interoperability endpoints
- sean.jackson@dchc.directbygreenway.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373414400000",
"number": "1114368917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 W 7 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482031968",
"telephone_number": "313-369-2600",
"fax_number": "313-369-2477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 W 7 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482031968",
"telephone_number": "313-369-2600",
"fax_number": "313-369-2477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SEAN",
"name_prefix": "Mr.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-10",
"last_updated": "2013-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902014962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.