The Practice of Anesthesia & Gen. Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

15374 Issued in MA

Legal business name

THE PRACTICE OF ANESTHESIA & GEN. DENTISTRY

Practice address

386 A/B Warren Street
Roxbury, MA 02119-0000

Phone

(800) 676-2750

NPI assigned

Mar 24, 2008

Organization subpart

Yes

Parent organization

LUE DEE JACKSON JR. DMD, MD DBA THE PRACTICE OF ANESTH. & GEN. DENT.As reported in NPPES

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

Authorized official

Name

Lue Dee Jackson Jr., DMD, MD

Title

Gen. Dentist & Anesthesiologist/Own

Phone

(800) 676-2750

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

The Practice of Anesthesia Gen Dentistry

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lue Dee Jackson Jr., DMD, MD

  • Dentist
  • Roxbury, MA
  • NPI 1568623841
  NPD (past)

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1417128042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 CLAREMONT PARK",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183002",
            "telephone_number": "800-676-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 A/B WARREN STREET",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021190000",
            "telephone_number": "800-676-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRACTICE OF ANESTHESIA & GEN. DENTISTRY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUE DEE JACKSON JR. DMD, MD DBA THE PRACTICE OF ANESTH. & GEN. DENT.",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LUE",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "GEN. DENTIST & ANESTHESIOLOGIST/OWN",
        "authorized_official_telephone_number": "800-676-2750",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "15374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0262331",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Terrell Sr.
• The Dimock Center
• The Hair Kingdom Inc
• The Osiris Family Institute, LLC
• The Osiris Group
• Christopher Stephen Theberge, RD
• Benley Stevenson Thompson, M.A.
• Hattie Rebecca Thorpe, LICSW
• Sarah Thurlow
• Kimberly Tyxine Thurmond, DPM

• Dental Clinic/Center in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.