Active NPI
Daniel Jackson, D.D.S
- Dentist
- Poplar Bluff, MO
National Provider Identifier
1124342803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 14158
- Practice address
- 821 W Pine St
Poplar Bluff, MO 63901-4956 - Phone
- (573) 785-6434
- Fax
- (573) 785-6435
- NPI assigned
- Mar 24, 2010
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 14158 | MO | Primary |
Addresses
Primary practice location
821 W Pine St
Poplar Bluff, MO 63901-4956
Mailing address
821 W Pine St
Poplar Bluff, MO 63901-4956
Phone (573) 785-6434
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 |
|---|---|---|---|
| 14158 | MO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daniel Jackson DDS PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Poplar Bluff, MO
- NPI 1225205362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1124342803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 W PINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639014956",
"telephone_number": "573-785-6434",
"fax_number": "573-785-6435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 W PINE ST",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639014956",
"telephone_number": "573-785-6434",
"fax_number": "573-785-6435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-24",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "14158",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.