Active NPI
Leonard Victor Jackson Jr., D.D.S.
- Dentist
- Richmond, VA
National Provider Identifier
1154549715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401411640
- Practice address
- 520 North 12TH Street
Suite #406
Richmond, VA 23298-0566 - Phone
- (804) 828-2977
- Fax
- (804) 828-3159
- NPI assigned
- Apr 20, 2007
- 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 | 0401411640 | VA | Primary |
Addresses
Primary practice location
520 North 12TH Street
Suite #406
Richmond, VA 23298-0566
Mailing address
520 N. 12TH Street
Suite #406
Richmond, VA 23298-0566
Phone (804) 828-2977
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 |
|---|---|---|---|
| 0401411640 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296172800000",
"number": "1154549715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 N. 12TH STREET",
"address_2": "SUITE #406",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232980566",
"telephone_number": "804-828-2977",
"fax_number": "804-828-3159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 NORTH 12TH STREET",
"address_2": "SUITE #406",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232980566",
"telephone_number": "804-828-2977",
"fax_number": "804-828-3159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LEONARD",
"middle_name": "VICTOR",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2011-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401411640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.