Carl Dennis Jackson, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS018783L Issued in PA

Practice address

3200 Concord Rd
Suite 200
Aston, PA 19014-1931

Phone

(610) 872-7461

Fax

(610) 494-7559

NPI assigned

May 9, 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

Medicare fee-for-service enrollment

Enrolled in PA

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.

• Aston Family Dental Care

  • Dental Clinic/Center
  • Aston, PA
  • NPI 1326361304
  NPD (past) Authorized official
• Chespenn Health Services

  • Federally Qualified Health Center (FQHC)
  • Coatesville, PA
  • NPI 1396799417
  NPD (past)
• Chespenn Health Services

  • Federally Qualified Health Center (FQHC)
  • Chester, PA
  • NPI 1750329603
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354838400000",
    "number": "1285848309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 WOODLARK LN",
            "city": "GLEN RIDDLE",
            "state": "PA",
            "postal_code": "190635706",
            "telephone_number": "610-358-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CONCORD RD",
            "address_2": "SUITE 200",
            "city": "ASTON",
            "state": "PA",
            "postal_code": "190141931",
            "telephone_number": "610-872-7461",
            "fax_number": "610-494-7559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARL",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2012-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS018783L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Iacono
• Infinite Family Services
• Infucare RX, LLC
• Innovative Muscle Therapy and Pain Center LLC
• Allen Gordon Irons Jr., R.PH.
• Janjay Eric Jackson, PHARMD
• Jason Delcollo, LLC
• Donald W Johnson, DC
• Nicole Grace Johnson, LCSW
• Joy Total Home Care

• Dentist in Aston, PA
• Providers in Aston, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.