Clayton Scott Jackson, DMD, MSD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10852 Issued in KY

Practice address

3934 Dutchmans LN
Louisville, KY 40207-4702

Phone

(502) 897-0625

Fax

(502) 618-4514

NPI assigned

Apr 24, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Schulten Pediatric Dentistry - New Albany LLC

  dba New Albany Pediatric Dentistry

  • Pediatric Dentistry
  • New Albany, IN
  • NPI 1285128512
  NPD
• University Pediatric Dentistry Associates

  • Pediatric Dentistry
  • Indianapolis, IN
  • NPI 1003947599
  NPD (past)

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1225692361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4317 CHARLESTOWN RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471508506",
            "telephone_number": "812-258-9626",
            "fax_number": "812-213-4190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3934 DUTCHMANS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074702",
            "telephone_number": "502-897-0625",
            "fax_number": "502-618-4514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "98 C Michael Davenport Blvd",
            "address_purpose": "LOCATION",
            "city": "Frankfort",
            "state": "KY",
            "postal_code": "406014333",
            "country_code": "US",
            "telephone_number": "502-223-7186",
            "fax_number": "502-996-8338",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4317 Charlestown Rd",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "IN",
            "postal_code": "471508506",
            "country_code": "US",
            "telephone_number": "812-258-9626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CLAYTON",
        "middle_name": "SCOTT",
        "credential": "DMD, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-24",
        "last_updated": "2023-01-17",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12013287A",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "10852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Willis Jackson, RDN
• Asia S Jackson
• Brittany Jackson, BA, MS
• Caroline N Jackson, MD
• Cheryl Gwendolyn Jackson, OTR/L
• Courtney Jackson
• Daisionne Jackson
• Deauanna Jackson
• Elizabeth Jackson
• Emily Jackson, DSW, LCSW

• Pediatric Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.