Leroy R Jackson Jr DDS PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LEROY R JACKSON JR DDS PLLC

Practice address

215 E 5TH Ave
Ranson, WV 25438-1613

Phone

(304) 725-8660

Fax

(304) 728-7519

NPI assigned

Jul 9, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Ellen Rossberg

Title

Owner

Phone

(904) 725-6634

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1497010136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E 5TH AVE",
            "city": "RANSON",
            "state": "WV",
            "postal_code": "254381613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 5TH AVE",
            "city": "RANSON",
            "state": "WV",
            "postal_code": "254381613",
            "telephone_number": "304-725-8660",
            "fax_number": "304-728-7519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEROY R JACKSON JR DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "ROSSBERG",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-725-6634",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna-Sue Lammie, NP
• Victoria Renee Lang
• Megan Marie Leap, PHARM D
• Morggan Marjorie Lee, FNP
• Laura Lindsay Leonard, DPT
• Esther Lin, MD
• Billie Little
• Jessica Alana-Lee Lloyd, FNP-C
• Daija Logut
• Amanda Leigh Lunsford

• Dental Clinic/Center in Ranson, WV
• Providers in Ranson, WV by specialty
• Dental Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.