Jackson Creek Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010765 Issued in IN

Legal business name

JACKSON CREEK DENTAL

Practice address

1124 S College Mall Rd
Bloomington, IN 47401

Phone

(812) 336-5525

Fax

(812) 332-5520

NPI assigned

Nov 11, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan David Tschettei, DDS

Title

Owner

Phone

(812) 336-5525

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lauren R Hoye, DDS

  • Dentist
  • Bloomington, IN
  • NPI 1497321665
  NPD (past)
• Ryan David Tschetter, DDS

  • General Practice Dentistry
  • Bloomington, IN
  • NPI 1457431629
  NPD (past)
• Whitney R Waldrup Marsh, DENTIST

  • Dentist
  • Bloomington, IN
  • NPI 1316424088
  NPD (past)

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

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1295062339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47401",
            "telephone_number": "812-336-5525",
            "fax_number": "812-332-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47401",
            "telephone_number": "812-336-5525",
            "fax_number": "812-332-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "TSCHETTEI",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-336-5525",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010765",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010729",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Ives-Glasgow, LMHCA
• J Keith Roberts DDS LLC
• J M C L Inc
• Samantha Jablonsky, RBT
• Jackson Creek Dental
• Brianne Jackson
• Emma Carol Jackson, PA-C
• Jeffrey L Jackson, MD
• Julia Jackson, RBT
• Libby Jackson, RBT

• General Practice Dentistry in Bloomington, IN
• Providers in Bloomington, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2018; 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.