Jackson Family Dental Gladstone LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JACKSON FAMILY DENTAL GLADSTONE LLC

Practice address

2109 NE 72ND St
Ste 104
Gladstone, MO 64118-2304

Phone

(816) 453-3100

Fax

(816) 453-3180

NPI assigned

Feb 2, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Lynn Jackson, D.D.S.

Title

Member

Phone

(816) 429-5799

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1422835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422835200000",
    "number": "1194115865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109 NE 72ND ST",
            "address_2": "STE 104",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641182304",
            "telephone_number": "816-453-3100",
            "fax_number": "816-453-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 NE 72ND ST",
            "address_2": "STE 104",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641182304",
            "telephone_number": "816-453-3100",
            "fax_number": "816-453-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FAMILY DENTAL GLADSTONE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-02",
        "last_updated": "2015-02-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "816-429-5799",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Kay Hyland, FNP-C
• Frank J Infranca, D.C.
• Inspire Adult Day Center LLC (Inspire Adult Day Center)
• Inspire Adult Day Center LLC (Inspire Adult Day Center)
• J.Reese Graue D.D.S. LLC (Gladstone Family Dentistry)
• James D Rubin O.D. PC
• James S Waddell DC PC (North Oak Chiropractic)
• Tayler James, PT, DPT
• Jayhawk Primary Care Inc (Creekwood Family Care)
• Jayhawk Primary Care Inc (Creekwood Urgent Care)

• General Practice Dentistry in Gladstone, MO
• Providers in Gladstone, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; 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.