Kevin R Jackson, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN012902 Issued in GA

Practice address

4150 Macland Rd
Suite 205
Powder Springs, GA 30127-1202

Phone

(770) 222-1344

Fax

(770) 222-1345

NPI assigned

Feb 1, 2007

Last updated

Jul 10, 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

Practice roles

Interoperability endpoints

• Direct secure messaging: kjackson40265@choa.gadirect.net

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

• Young Smiles Dentistry for Kids

  • Pediatric Dentistry
  • Powder Springs, GA
  • NPI 1174832802
  NPD (past) Authorized official

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1265570683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5605 MAXON MARSH DR",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301412880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 MACLAND RD",
            "address_2": "SUITE 205",
            "city": "POWDER SPRINGS",
            "state": "GA",
            "postal_code": "301271202",
            "telephone_number": "770-222-1344",
            "fax_number": "770-222-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEVIN",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ijose Abieyuwa Iyabor
• J.Dewar Surgical Services LLC
• Brionka Jackson, RBT
• Dominique Jackson
• Felton Lewis Jackson III
• Latasha Marie Jackson
• Robert John Jacobs, LPC
• Cynthia Ann Jaworski, A.T.,C
• Evens Jean-Louis
• Demetria Jennings, LMSW

• Pediatric Dentistry in Powder Springs, GA
• Providers in Powder Springs, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.