Jesse L Jackson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2010016173 Issued in MO

Practice address

8650 NE Shoal Creek Valley Dr
Kansas City, MO 64157-8063

Phone

(816) 429-5799

NPI assigned

May 25, 2010

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Jackson Family Dental LLC

  • General Practice Dentistry
  • Kansas City, MO
  • NPI 1851781520
  NPD Authorized official

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

{
    "created_epoch": "1274745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1235458514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8650 NE SHOAL CREEK VALLEY DR",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641578063",
            "telephone_number": "816-429-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8650 NE SHOAL CREEK VALLEY DR",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641578063",
            "telephone_number": "816-429-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JESSE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-25",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MO",
            "license": "2010016173",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2010016173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dasia T Jackson
• Dawn M Jackson, MD
• Dorothy Jean Jackson, MD
• Frances Jackson
• Holly Jackson, LMSW
• Jessica Lenae Jackson
• Jodi K Jackson, MD
• Julia Todd Jackson, RN
• Katherine S.T. Jackson, LPC
• Kenneth Dolen Jackson, MD

• General Practice Dentistry in Kansas City, MO
• Providers in Kansas City, 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 Nov 10, 2025; 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.