Centerille Pediatric Dentistry, Kyle R Jackson, DDS, Inc

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30018976 Issued in OH

Legal business name

CENTERILLE PEDIATRIC DENTISTRY, KYLE R JACKSON, DDS, INC

Practice address

273 Regency Ridge Dr
Centerville, OH 45459-4221

Phone

(937) 586-7729

Fax

(937) 660-4450

NPI assigned

Nov 2, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Kyle R. Jackson, DDS

Title

Dentist/Owner

Phone

(937) 586-7729

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470873600000",
    "number": "1386073112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 REGENCY RIDGE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594221",
            "telephone_number": "937-586-7729",
            "fax_number": "937-660-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 REGENCY RIDGE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594221",
            "telephone_number": "937-586-7729",
            "fax_number": "937-660-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERILLE PEDIATRIC DENTISTRY, KYLE R JACKSON, DDS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2016-08-11",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "937-586-7729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30018976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan A. Cargill, LPCC
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• Pediatric Dentistry in Centerville, OH
• Providers in Centerville, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; 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.