Active NPI
Kristin M Jackson, D.D.S., M.S.D.
- Periodontics
- Greenwood, IN
National Provider Identifier
1174616825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 12009767
- Practice address
- 45 N Madison Ave
Greenwood, IN 46142-3526 - Phone
- (317) 887-3180
- Fax
- (317) 882-2718
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 12009767 | IN | Primary |
Addresses
Primary practice location
45 N Madison Ave
Greenwood, IN 46142-3526
Mailing address
45 N Madison Ave
Greenwood, IN 46142-3526
Phone (317) 887-3180
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 |
|---|---|---|---|
| 12009767 | IN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308182400000",
"number": "1174616825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 N MADISON AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461423526",
"telephone_number": "317-887-3180",
"fax_number": "317-882-2718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45 N MADISON AVE",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461423526",
"telephone_number": "317-887-3180",
"fax_number": "317-882-2718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KRISTIN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2011-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IN",
"license": "12009767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.