Chelsea Lynn Jackson

Primary specialty

DentistTaxonomy code 122300000X

License

D010374 Issued in AZ

Practice address

42201 N 41St Dr Ste 156
Anthem, AZ 85086-3803

Phone

(623) 551-3511

NPI assigned

Aug 26, 2019

Sex

Female

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)

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.

• Anthem Dentist

  • General Practice Dentistry
  • Anthem, AZ
  • NPI 1407632896
  NPD
• Arizona Heights Dentistry@Anthem PC

  • General Practice Dentistry
  • Anthem, AZ
  • NPI 1699739987
  NPD (past)

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1235786013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 W WEBSTER CT",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850861854",
            "telephone_number": "602-405-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42201 N 41ST DR STE 156",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "850863803",
            "telephone_number": "623-551-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHELSEA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.025964",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D010374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam Ile
• Helene M Illston, M.T.
• Infinite Path Solutions LLC
• Integrity Wound Healing Solutions LLC
• Interaactive Speech Therapy
• Rodney Mark Jackson, MD,FAAP
• Sadaf Jamil, DO
• JH Dental
• JL Shaughnessy Dental Associates
• John C Lincoln LLC

• Dentist in Anthem, AZ
• Providers in Anthem, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; 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.