Lue Dee Jackson Jr., DMD, MD

Primary specialty

DentistTaxonomy code 122300000X

License

15374 Issued in MA

Practice address

386 A-B Warren Street
Roxbury, MA 02119

Phone

(800) 676-2750

NPI assigned

Jun 19, 2008

Last updated

Jun 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Dentist

Education

Other, 1979

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Shoshone-Paiute Tribes

  dba Owyhee Community Health Facility

  • Clinic/Center
  • Owyhee, NV
  • NPI 1528230224

  TX

  Medicare reassignment NPD
• Shoshone Paiute Tribes

  dba Owyhee Ambulance

  • Land Ambulance
  • Owyhee, NV
  • NPI 1104181791
  NPD
• The Practice of Anesthesia & Gen. Dentistry

  • Dental Clinic/Center
  • Roxbury, MA
  • NPI 1417128042
  NPD (past)

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213833600000",
    "number": "1568623841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 CLAREMONT PARK",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021183002",
            "telephone_number": "800-676-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 A-B WARREN STREET",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "02119",
            "telephone_number": "800-676-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LUE DEE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2008-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "15374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0262331",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson
• Adriaenna Jackson-Adams
• Ajaycia Jackson
• Danhai L Jackson
• Lornannette Jackson
• Shynna Jackson
• Trevor Jakes
• Elizabeth James Divens, M.ED
• Aja James-Hughes
• Melodieann I James-Stewart

• Dentist in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.