NPIMap

Individual provider Active NPI

Amanda Jackson, D.D.S.

  • General Practice Dentistry
  • Covington, WA
National Provider Identifier
1437370582
Registry record updated Nov 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE 60447313 Issued in WA
Practice address
27081 185TH Ave SE
Ste B105
Covington, WA 98042-8448
Phone
(253) 981-4950
Fax
(253) 981-4952
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 54679 CA
General Practice Dentistry 1223G0001X DE 60447313 WA Primary
General Practice Dentistry 1223G0001X 8846 KY

Addresses

Primary practice location

27081 185TH Ave SE
Ste B105
Covington, WA 98042-8448

Mailing address

27081 185TH Ave SE
Ste B105
Covington, WA 98042-8448
Phone (253) 981-4950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8846KYMDGeneral Practice Dentistry
DE 60447313WAMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416787200000",
    "number": "1437370582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27081 185TH AVE SE",
            "address_2": "STE B105",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980428448",
            "telephone_number": "253-981-4950",
            "fax_number": "253-981-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27081 185TH AVE SE",
            "address_2": "STE B105",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980428448",
            "telephone_number": "253-981-4950",
            "fax_number": "253-981-4952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2014-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "54679",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE 60447313",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8846",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; 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.