Active NPI
Ronald Todd Jackson, D.M.D.
- General Practice Dentistry
- Jacksonville, FL
National Provider Identifier
1285762690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN00012333
- Practice address
- 1803 University Blvd N
Jacksonville, FL 32211-4523 - Phone
- (904) 743-3011
- Fax
- (904) 743-3016
- NPI assigned
- Feb 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN00012333 | FL | Primary |
Addresses
Primary practice location
1803 University Blvd N
Jacksonville, FL 32211-4523
Mailing address
11430 Starboard Dr
Jacksonville, FL 32225-4045
Phone (904) 646-5997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN00012333 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285762690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11430 STARBOARD DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322254045",
"telephone_number": "904-646-5997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1803 UNIVERSITY BLVD N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322114523",
"telephone_number": "904-743-3011",
"fax_number": "904-743-3016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RONALD",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN00012333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- 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.