Active NPI
Jennifer Jackson, D.D.S.
- Pediatric Dentistry
- Aurora, CO
National Provider Identifier
1356887038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 15469
- Practice address
- 1575 Wheeling St
Aurora, CO 80045-7228 - Phone
- (720) 777-6788
- NPI assigned
- Jan 18, 2017
- Last updated
- Jan 22, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 15469 | MT | Primary |
Addresses
Primary practice location
1575 Wheeling St
Aurora, CO 80045-7228
Mailing address
795 Sunset Blvd Ste C
Kalispell, MT 59901-3610
Phone (406) 752-8302
Other practice location 1
795 Sunset Blvd Ste C
Kalispell, MT 59901-3610
Phone (406) 752-8302
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 |
|---|---|---|---|
| 15469 | MT | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Sky Pediatric Dentistry PLLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pediatric Dentistry
- Kalispell, MT
- NPI 1730921289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548115200000",
"number": "1356887038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "795 SUNSET BLVD STE C",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599013610",
"telephone_number": "406-752-8302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 WHEELING ST",
"city": "AURORA",
"state": "CO",
"postal_code": "800457228",
"telephone_number": "720-777-6788"
}
],
"practiceLocations": [
{
"address_1": "795 Sunset Blvd Ste C",
"address_purpose": "LOCATION",
"city": "Kalispell",
"state": "MT",
"postal_code": "599013610",
"country_code": "US",
"telephone_number": "406-752-8302",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNIFER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-18",
"last_updated": "2019-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MT",
"license": "15469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.