NPIMap

Organization Active NPI

Eli Jackson III PSC

Doing business as Chandler Park Dental Care

  • Dentist
  • Bowling Green, KY
National Provider Identifier
1447638168
Registry record updated Sep 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5450 Issued in KY
Legal business name
ELI JACKSON III PSC
Doing business as
Chandler Park Dental Care
Practice address
1857 Tucker Way
Bowling Green, KY 42104-6258
Phone
(270) 781-2952
Fax
(270) 793-0977
NPI assigned
May 14, 2015
Last updated
Sep 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2016

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

Authorized official

Name
Eli O Jackson III, DMDNPI 1710959218
Title
Owner
Phone
(270) 781-2952

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5450 KY Primary

Addresses

Primary practice location

1857 Tucker Way
Bowling Green, KY 42104-6258

Mailing address

1857 Tucker Way
Bowling Green, KY 42104-6258
Phone (270) 781-2952

Other names 1

  • CHANDLER PARK DENTAL CARE Doing business as

National Provider Directory

National Provider Directory

Locations

1857 Tucker Way
Bowling Green, KY 42104
Phone (270) 781-2952

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1431561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473811200000",
    "number": "1447638168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1857 TUCKER WAY",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421046258",
            "telephone_number": "270-781-2952",
            "fax_number": "270-793-0977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1857 TUCKER WAY",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421046258",
            "telephone_number": "270-781-2952",
            "fax_number": "270-793-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELI JACKSON III PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-14",
        "last_updated": "2016-09-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ELI",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-781-2952",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "KY",
            "license": "5450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHANDLER PARK DENTAL CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.