Larry Tyler Jackson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D009113 Issued in AZ

Practice address

14100 N 83Rd Ave
Ste 280
Peoria, AZ 85381-5658

Phone

(623) 935-9873

NPI assigned

Jul 8, 2013

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

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.

• Growing Grins PLLC

  • Pediatric Dentistry
  • Gilbert, AZ
  • NPI 1326128356
  NPD (past)

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

{
    "created_epoch": "1373241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491523200000",
    "number": "1396186276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 N 83RD AVE",
            "address_2": "STE 280",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815658",
            "telephone_number": "623-935-9873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14100 N 83RD AVE",
            "address_2": "STE 280",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815658",
            "telephone_number": "623-935-9873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LARRY",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-08",
        "last_updated": "2017-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D009113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J. Barton Ripperger DPM PC
• Jack Hawks PC
• Fay A Jackson
• Jerome Alexander-Terrell Jackson
• Julian Jackson
• Lyndzie Jackson
• Julie Jacobs, D.O.
• Kaisa T Jacobsen, NP
• Sheddler Straus Jacques, PA
• Dawn Jaeger

• Pediatric Dentistry in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2017; 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.