Active NPI
Robert Anthony Jackson, D.M.D.
- General Practice Dentistry
- Owensboro, KY
National Provider Identifier
1457515330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8609
- Practice address
- 2816 Veach Rd.
Unit 305
Owensboro, KY 42303 - Phone
- (270) 386-5344
- Fax
- (270) 683-3519
- NPI assigned
- Jul 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8609 | KY | Primary |
Addresses
Primary practice location
2816 Veach Rd.
Unit 305
Owensboro, KY 42303
Mailing address
2816 Veach Rd.
Unit 305
Owensboro, KY 42303
Phone (270) 683-5344
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8609 | KY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1457515330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2816 VEACH RD.",
"address_2": "UNIT 305",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "42303",
"telephone_number": "270-683-5344",
"fax_number": "270-683-3519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2816 VEACH RD.",
"address_2": "UNIT 305",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "42303",
"telephone_number": "270-386-5344",
"fax_number": "270-683-3519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROBERT",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "8609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owensboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.