Active NPI
Zachary Eric Jaeckel, DDS
- General Practice Dentistry
- Clovis, CA
National Provider Identifier
1528886173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 110713
- Practice address
- 100 N Clovis Ave
Clovis, CA 93612 - Phone
- (559) 431-5551
- Fax
- (559) 431-5677
- NPI assigned
- Oct 2, 2024
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 110713 | CA | Primary |
Addresses
Primary practice location
100 N Clovis Ave
Clovis, CA 93612
Mailing address
7659 N Sanders
Clovis, CA 93619
Phone (559) 473-6987
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 |
|---|---|---|---|
| 110713 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727827200000",
"number": "1528886173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7659 N SANDERS",
"city": "CLOVIS",
"state": "CA",
"postal_code": "93619",
"telephone_number": "559-473-6987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N CLOVIS AVE",
"city": "CLOVIS",
"state": "CA",
"postal_code": "93612",
"telephone_number": "559-431-5551",
"fax_number": "559-431-5677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAECKEL",
"first_name": "ZACHARY",
"middle_name": "ERIC",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-02",
"last_updated": "2024-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "110713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.