Jacky Clay Standlee, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

014960 Issued in MO

Practice address

Westside Dental 994 Diamond Ridge
Ste 202
Jefferson City, MO 65109

Phone

(573) 893-4402

Fax

(573) 632-4398

NPI assigned

Aug 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265442107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 WARDSVILLE RD",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651018744",
            "telephone_number": "573-634-7313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WESTSIDE DENTAL 994 DIAMOND RIDGE",
            "address_2": "STE 202",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "65109",
            "telephone_number": "573-893-4402",
            "fax_number": "573-632-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANDLEE",
        "first_name": "JACKY",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "014960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• State of Missouri (Cstar)
• State of Missouri (TCM Youth)
• State of Missouri
• State of Missouri (Division of Youth Services)

• Dentist in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.