Daniel Jackson DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14158 Issued in MO

Legal business name

DANIEL JACKSON DDS PC

Practice address

821 West Pine Blvd
Poplar Bluff, MO 63901-4956

Phone

(573) 785-6434

Fax

(573) 785-6435

NPI assigned

May 8, 2008

Last updated

May 8, 2008By 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. Daniel Jackson, DDSNPI 1124342803

Title

Corporate President

Phone

(573) 785-6434

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Daniel Jackson, D.D.S

  • Dentist
  • Poplar Bluff, MO
  • NPI 1124342803
  NPD (past) Authorized official
• George Frederick Blaich V, D.D.S.

  • General Practice Dentistry
  • Poplar Bluff, MO
  • NPI 1871812073
  NPD (past)

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1225205362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WEST PINE BLVD",
            "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 WEST PINE BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014956",
            "telephone_number": "573-785-6434",
            "fax_number": "573-785-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL JACKSON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CORPORATE PRESIDENT",
        "authorized_official_telephone_number": "573-785-6434",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Gail Cunningham
• Malachi Colm Curnutt
• Dillon Matthew Curry
• Kristen Deanne Daggett
• Jeffrey Lee Dakas, M.D.
• Lori Daniel, PH.D.
• Dennis Edwards Daniels, MD
• Chasidy Darnell
• Gary W Dausmann, MD
• Reeca Daves, D.D.S.

• General Practice Dentistry in Poplar Bluff, MO
• Providers in Poplar Bluff, 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 May 8, 2008; 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.