Cody Jackson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D11459 Issued in OR

Practice address

8660 SW Scholls Ferry Rd
Beaverton, OR 97008-6621

Phone

(503) 616-9177

NPI assigned

Jun 29, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1538739735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 PERKINS ST NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973039600",
            "telephone_number": "503-884-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8660 SW SCHOLLS FERRY RD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970086621",
            "telephone_number": "503-616-9177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CODY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivys Massage and Bodywork
• Katarzyna Barbara Iwan, M.D.
• Naoya Izawa, PSY.D.
• Lisa Jackman
• Melody Jackman, MA, CMHC
• Ian Jackson
• Jan Leslie Jackson, PHYSICAL THERAPIST
• Joshua Jackson
• Kathleen Marie Jackson, RDH
• Jeffrey Jacky, DENTURIST LD

• Dentist in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.