Brent Jackson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901021258 Issued in MI

Practice address

456 S Main St
Lapeer, MI 48446-2427

Phone

(810) 667-3535

NPI assigned

Jun 23, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Sleep Centers PLLC

  • Dentist
  • Dunlap, IL
  • NPI 1265887210
  NPD (past) Authorized official
• Jackson Dental

  • Dentist
  • Lapeer, MI
  • NPI 1407120504
  NPD (past)
• Tru Dental Michigan II, PLLC

  • General Practice Dentistry
  • Lapeer, MI
  • NPI 1588249932
  NPD (past)

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1447665013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "456 S MAIN ST",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484462427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 S MAIN ST",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484462427",
            "telephone_number": "810-667-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRENT",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intimate Wellness LLC
• James Iordanou, DO
• Irb Medical Equipment, LLC
• Jessica Jackowski, RDN
• Jackson Dental
• Luan Kay Jackson, RN
• Mary Ann James
• Reese James, D.O.
• Jan C Gromada DO Facoog PLLC
• Gloria Janisz

• Dentist in Lapeer, MI
• Providers in Lapeer, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.