Active NPI
Jackson Cockley, DDS
- Pediatric Dentistry
- Mansfield, OH
National Provider Identifier
1487740114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 30021945
- Practice address
- 1145 Aspira CT
Mansfield, OH 44906-4125 - Phone
- (419) 774-7529
- Fax
- (419) 774-7529
- NPI assigned
- Oct 4, 2006
- Last updated
- Jan 3, 2012
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 30021945 | OH | Primary |
Addresses
Primary practice location
1145 Aspira CT
Mansfield, OH 44906-4125
Mailing address
1145 Aspira CT
Mansfield, OH 44906-4125
Phone (419) 774-7529
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2704818 | Medicaid | OH |
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 |
|---|---|---|---|
| 30021945 | OH | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cockley's Playtime Dental | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325548800000",
"number": "1487740114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 ASPIRA CT",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449064125",
"telephone_number": "419-774-7529",
"fax_number": "419-774-7529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 ASPIRA CT",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449064125",
"telephone_number": "419-774-7529",
"fax_number": "419-774-7529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COCKLEY",
"first_name": "JACKSON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2012-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "30021945",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2704818",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.