Ryan Michael Jack, D.D.S., M.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

10046 Issued in CO

Practice address

8580 Scarborough Dr
#200
Colorado Springs, CO 80920-7583

Phone

(719) 282-6600

NPI assigned

Jan 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277596800000",
    "number": "1538130752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 SCARBOROUGH DR",
            "address_2": "#200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207583",
            "telephone_number": "719-282-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8580 SCARBOROUGH DR",
            "address_2": "#200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207583",
            "telephone_number": "719-282-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D-3585",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN18177",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "10046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ja Rides LLC
• Amanda Jabaay
• Nader Nabeel Jabbour, P.T.
• Blake Edward Jachimek
• Jack Ford MD PC
• Sharley Rene Jackman, RD
• Jacks Axe Throwing
• Kimberly A. Jacksi, RN
• Dell Ann Jackson-Golia
• Mary Yvette Jackson-Webb, LCSW,LAC,MAC,CIMHP

• Endodontics in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Endodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.