Christopher John Jackson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D0633 Issued in SD

Practice address

503 Jackson St
Belle Fourche, SD 57717-1716

Phone

(605) 892-6347

Fax

(605) 892-6564

NPI assigned

Jun 12, 2007

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 SD

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

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 Dental Prof. LLC

  • Dentist
  • Belle Fourche, SD
  • NPI 1144394545
  NPD (past) Authorized official

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457555658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 JACKSON ST",
            "city": "BELLE FOURCHE",
            "state": "SD",
            "postal_code": "577171716",
            "telephone_number": "605-892-6347",
            "fax_number": "605-892-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 JACKSON ST",
            "city": "BELLE FOURCHE",
            "state": "SD",
            "postal_code": "577171716",
            "telephone_number": "605-892-6347",
            "fax_number": "605-892-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "JOHN",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SD",
            "license": "D0633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Highland Health PLLC
• Highland Hills LLC
• Inner-Mountain Family Resources, Inc.
• Cailey Iverson, DPT
• Jackson Dental Prof. LLC
• John H Jackson
• Mason Lee Jensen, DDS
• Steve A Jewett
• Abby J. Johnson, D.C.
• Judy'S Assisted Living

• All providers in Belle Fourche, SD
• General Practice Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.