Jackson Dental Alliance, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JACKSON DENTAL ALLIANCE, PLLC

Practice address

40 W Caldwell St Ste 202
Mt Juliet, TN 37122-3179

Phone

(615) 758-7511

NPI assigned

Apr 14, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Corey Jackson, DDSNPI 1548281017

Title

President/Ceo

Phone

(615) 406-6780

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Ronald Corey Jackson, D.D.S.

  • General Practice Dentistry
  • Mt Juliet, TN
  • NPI 1548281017
  NPD Authorized official

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

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1396431060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 S MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371226202",
            "telephone_number": "615-406-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 W CALDWELL ST STE 202",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371223179",
            "telephone_number": "615-758-7511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DENTAL ALLIANCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "COREY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "615-406-6780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Remonda Ishak
• Farah Adel Ismail, PHARMD
• Chidinma Iwueke
• Amanda G Jack
• Kailee Jackola
• Amber Jackson
• Jamill Jackson
• Kristin Rashawn Jackson, RBT
• Ronald Corey Jackson, D.D.S.
• Kristen M Jacobsen

• Dental Clinic/Center in Mt Juliet, TN
• Providers in Mt Juliet, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.

Verify at the official NPI Registry.