NPIMap

Organization Active NPI

Jackson Periodontics

  • Periodontics
  • Greenwood, IN
National Provider Identifier
1427143643
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
12009767 Issued in IN
Legal business name
JACKSON PERIODONTICS
Doing business as
Indiana Periodontics
Practice address
45 N Madison Ave
Greenwood, IN 46142-3526
Phone
(317) 887-3180
Fax
(317) 882-2718
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Dr. Kristin M Jackson, DDS, MSD
Title
Owner
Phone
(317) 887-3180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 12009767 IN Primary

Addresses

Primary practice location

45 N Madison Ave
Greenwood, IN 46142-3526

Mailing address

45 N Madison Ave
Greenwood, IN 46142-3526
Phone (317) 887-3180

Other names 1

  • Indiana Periodontics Doing business as

National Provider Directory

National Provider Directory

Locations

45 N Madison Ave
Greenwood, IN 46142
Phone (317) 887-7624

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1427143643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 N MADISON AVE",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461423526",
            "telephone_number": "317-887-3180",
            "fax_number": "317-882-2718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 N MADISON AVE",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461423526",
            "telephone_number": "317-887-3180",
            "fax_number": "317-882-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-887-3180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12009767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indiana Periodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.