Harry Keith Jackson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2140 Issued in WV

Practice address

116 Hills PLZ
Charleston, WV 25387-2438

Phone

(304) 720-4466

Fax

(304) 720-4813

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WV

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

Practice roles

Locations

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.

• Womencare, Inc

  • Federally Qualified Health Center (FQHC)
  • Madison, WV
  • NPI 1740450089
  Medicare reassignment NPD
• Womencare Inc

  • Federally Qualified Health Center (FQHC)
  • Winfield, WV
  • NPI 1477834216
  NPD
• Womencare Inc

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1770745036
  NPD
• Womencare Inc

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1871872184
  NPD
• Womencare, Inc

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1972773224
  NPD

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1336234640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 GREAT TEAYS BLVD STE 6",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609816",
            "telephone_number": "304-720-4466",
            "fax_number": "304-720-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 HILLS PLZ",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253872438",
            "telephone_number": "304-720-4466",
            "fax_number": "304-720-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HARRY",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "2140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336234640",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0135354000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Mae Jackson
• Chynna Rajae Jackson
• David Alexander Jackson, PRSS
• Denise Jackson
• Dominion Alecia Jackson
• James M Jackson, COUNSELOR 3
• Judy Jackson
• Krystal Jackson
• Laqwanza Jackson
• Leslie Jackson

• General Practice Dentistry in Charleston, WV
• Providers in Charleston, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; 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.