Ann Marie Jackson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4280 Issued in WV

Practice address

1 Medical Center Dr RM 1200
Morgantown, WV 26506-1200

Phone

(304) 293-6109

NPI assigned

Jul 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499817600000",
    "number": "1467974253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 VALLEY VIEW AVE APT 304",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265053670",
            "telephone_number": "304-667-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR RM 1200",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265061200",
            "telephone_number": "304-293-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "4280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV CHIP",
            "identifier": "1841271459",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841271459",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rubinya Sundar Iyer, B.D.S.
• Nabil M. Jabbour, M.D.
• Danielle Jablonski, FNP-C
• Ahleeyah Jackson
• Alexandria C Jackson
• Charles Russell Jackson, DDS
• Christa Jackson
• James Fred Jackson, DDS
• Kandis Jackson
• Lyndsay Marie Jackson, DPT

• Dentist in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Dentist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; 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.