Walter Charles Jackson, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5927 Issued in LA

Practice address

4051 Veterans Memorial Blvd
Suite 200
Metairie, LA 70002-5572

Phone

(504) 455-7161

Fax

(504) 455-7162

NPI assigned

May 6, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245196800000",
    "number": "1255507588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4051 VETERANS MEMORIAL BLVD STE 200",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700025567",
            "telephone_number": "504-455-7161",
            "fax_number": "504-455-7162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4051 VETERANS MEMORIAL BLVD",
            "address_2": "SUITE 200",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700025572",
            "telephone_number": "504-455-7161",
            "fax_number": "504-455-7162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "WALTER",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-06",
        "last_updated": "2009-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "5927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheneda L Jackson, RD
• Tanya Talita Jackson
• Taylor Allyse Jackson, PA
• Toia Tiara Jackson
• Tremeisya Marche Jackson
• Jacob Dent DDS Dentists of Metairie a Professional Corporation
• Jacob Dent DDS. Metairie Modern Dentistry a Professional Corporation
• Jacob General Surgery, LLC
• Jasmine Jacob
• Leah Gonsoulin Jacob, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Metairie, LA
• Providers in Metairie, LA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; 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.