Jackson L. Sullivan D.D.S., P.C.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

5244 Issued in OK

Legal business name

JACKSON L. SULLIVAN D.D.S., P.C.

Practice address

609 S Kelly Ave Ste E1
Edmond, OK 73003-7501

Phone

(405) 844-8444

Fax

(405) 844-8440

NPI assigned

Apr 20, 2007

Organization subpart

Yes

Parent organization

JACKSON L. SULLIVAN D.D.S., P.C.As reported in NPPES

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

Authorized official

Name

Dr. Jackson L Sullivan, DDSNPI 1194733725

Title

Doctor

Phone

(405) 844-8444

Specialties & licenses 1

Addresses

Other names 1

• Edmond Endodontics Other name

Part of

Jackson L Sullivan DDS PC

Locations

Practitioners 1

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

• Jackson Lee Sullivan, D.D.S., PA

  • Endodontics
  • Bradenton, FL
  • NPI 1194733725
  NPD (past) Authorized official

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1336366244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 S KELLY AVE STE E1",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730037501",
            "telephone_number": "405-844-8444",
            "fax_number": "405-844-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 S KELLY AVE STE E1",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730037501",
            "telephone_number": "405-844-8444",
            "fax_number": "405-844-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON L. SULLIVAN D.D.S., P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON L. SULLIVAN D.D.S., P.C.",
        "enumeration_date": "2007-04-20",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "405-844-8444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "OK",
            "license": "5244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edmond Endodontics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Betsy Ann Ittickathra, DO
• Ivedco, LLC
• Jordyn Ives, BCBA
• J & M Bowles LLC
• Jackson Chiropractic Clinic PC
• Aleka Jaquaya Jackson
• Anthony Jackson
• Dominique Jackson
• Gwen D Jackson, RBT
• James Jason Jackson, MD

• Endodontics in Edmond, OK
• Providers in Edmond, OK by specialty
• Endodontics in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.