Jackson Lawler Anderson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

104589 Issued in CO

Practice address

6459 Omaha Blvd
Colorado Springs, CO 80915-2618

Phone

(719) 597-9057

Fax

(719) 597-2189

NPI assigned

May 22, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

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

State licenses

Practice roles

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.

• Nichol Family Dentistry, LLC

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1023773488
  NPD (past)

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275742488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6459 OMAHA BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809152618",
            "telephone_number": "719-597-9057",
            "fax_number": "719-597-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6459 OMAHA BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809152618",
            "telephone_number": "719-597-9057",
            "fax_number": "719-597-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACKSON",
        "middle_name": "LAWLER",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "104589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PAYOR ID",
            "identifier": "010274",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erick Trevor Anderson, DMD, PC
• Erik Allen Anderson, DO
• Erik William Anderson, M.D.
• Gabriel Clint Anderson
• Hayley Anderson
• James T Anderson, M.D.
• Jane Y Anderson, D.C., F.I.A.M.A.
• Janet Sue Anderson, N.P.
• Jantzen Lynn Anderson, DDS
• Jocelyn Anderson

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• 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.
• 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.