Active NPI
Terrance Lorne Jackson, DMD
- Dentist
- Chicago, IL
National Provider Identifier
1356929335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.033509
- Practice address
- 6260 N Broadway St
Chicago, IL 60660-1968 - Phone
- (773) 627-0111
- NPI assigned
- Mar 31, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 019.033509 | IL | Primary |
Addresses
Primary practice location
6260 N Broadway St
Chicago, IL 60660-1968
Mailing address
169 W Huron St Unit 1105
Chicago, IL 60654-3612
Phone (706) 619-6159
Other practice location 1
2138 Madison Ave
Toledo, OH 43604-5131
Phone (419) 241-6215
Other practice location 2
8301 S Holland Rd Ste B
Chicago, IL 60620-1303
Phone (773) 488-2444
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 |
|---|---|---|---|
| 019.033509 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Smiles P.C. | Dentist | 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 and National Provider Directory roles.
-
- Dentist
- Chicago, IL
- NPI 1689079675
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1356929335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 W HURON ST UNIT 1105",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543612",
"telephone_number": "706-619-6159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6260 N BROADWAY ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606601968",
"telephone_number": "773-627-0111"
}
],
"practiceLocations": [
{
"address_1": "2138 Madison Ave",
"address_purpose": "LOCATION",
"city": "Toledo",
"state": "OH",
"postal_code": "436045131",
"country_code": "US",
"telephone_number": "419-241-6215",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "8301 S Holland Rd Ste B",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606201303",
"country_code": "US",
"telephone_number": "773-488-2444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "TERRANCE",
"middle_name": "LORNE",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-03-31",
"last_updated": "2023-05-10",
"certification_date": "2023-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.033509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.