Jacksonville Smiles

Primary specialty

DentistTaxonomy code 122300000X

License

30949 Issued in TX

Legal business name

JACKSONVILLE SMILES

Practice address

606 Brookside Dr
Jacksonville, TX 75766-2519

Phone

(903) 586-1551

Fax

(903) 586-1552

NPI assigned

Jul 23, 2015

Last updated

Jul 23, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wyatt Seth Checketts, DDS

Title

Owner/Dentist

Phone

(903) 586-1551

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Michael Dwaine Banks, D.D.S.

  • General Practice Dentistry
  • Jacksonville, TX
  • NPI 1497971097
  NPD (past)

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437609600000",
    "number": "1457736100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 BROOKSIDE DR",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662519",
            "telephone_number": "903-586-1551",
            "fax_number": "903-586-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 BROOKSIDE DR",
            "city": "JACKSONVILLE",
            "state": "TX",
            "postal_code": "757662519",
            "telephone_number": "903-586-1551",
            "fax_number": "903-586-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-23",
        "last_updated": "2015-07-23",
        "status": "A",
        "authorized_official_last_name": "CHECKETTS",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "SETH",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "903-586-1551",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "30949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacksonville Hospital LLC
• Jacksonville I Enterprises LLC (The Trinity Assisted Living of Jacksonville)
• Jacksonville Independent School District
• Jacksonville Opco, LLC (Angelina House)
• Jacksonville SCC, LLC (Senior Care of Jacksonville)
• James a. Thurow, D.O., P.a.
• James R Low, Jr., M.D.,P.a.
• Jordan January, FNP
• Jimmy B Harkins MD
• Daphne Johnson

• Dentist in Jacksonville, TX
• Providers in Jacksonville, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; 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.