Jackson Pediatric Dentistry LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

JACKSON PEDIATRIC DENTISTRY LLC

Practice address

1236 Ebenezer Rd
Suite 110
Rock Hill, SC 29732-3390

Phone

(803) 324-7540

Fax

(803) 324-4128

NPI assigned

Jun 7, 2016

Last updated

Aug 3, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephanie Lynn Jackson, DDS, MS

Title

Pediatric Dentist

Phone

(919) 412-4199

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tonya Powers Cleveland, MD

  • Anesthesiology Physician
  • Smyrna, SC
  • NPI 1124061593
  NPD (past)
• Charles Harmon Crawford Jr., DMD

  • Pediatric Dentistry
  • Rock Hill, SC
  • NPI 1740288844
  NPD (past)
• Brett Standard Cleveland, MD

  • Anesthesiology Physician
  • Gastonia, NC
  • NPI 1518901420
  NPD (past)

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470182400000",
    "number": "1144679507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 HIGHWAY 160 W",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088024",
            "telephone_number": "803-548-2333",
            "fax_number": "803-548-2703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 EBENEZER RD",
            "address_2": "SUITE 110",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323390",
            "telephone_number": "803-324-7540",
            "fax_number": "803-324-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-08-03",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "919-412-4199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivx Health of South Carolina, P.C. (IVX Health)
• Ivyrehab Focus, Inc.
• J. Michele Boyne, D.M.D. LLC
• J. Michele Boyne, DMD, L.L.C.
• Natalie Jacewicz, M.ED
• Breanna Jackson, RBT
• Margaret Jackson
• Marsha D Jackson, M.ED.,L.M.S.W.,L.P.C
• Michael Latrelle Jackson
• Tiffany Denise Jackson, MD

• Pediatric Dentistry in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; 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.