Joseph Daniel Jackson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026468 Issued in IL

Practice address

2900 41St St
Moline, IL 61265-7823

Phone

(309) 764-3242

NPI assigned

Jan 30, 2007

Last updated

Jan 24, 2013By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• LJ Dentistry LLC

  • General Practice Dentistry
  • Moline, IL
  • NPI 1760753362
  NPD (past) Authorized official

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358985600000",
    "number": "1598801011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 41ST ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657823",
            "telephone_number": "309-764-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 41ST ST",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657823",
            "telephone_number": "309-764-3242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2013-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arled Izquierdo, MD
• J & S Kelly LLC (Kelly's Medical Equipment & Supply)
• J a K Enterprises Inc (Bard Optical)
• Harvey P Jack, D.C.
• Benjamin Joseph Jackson, DMD
• Adam Jacobsen, D.C.
• Nicholas Jagush, DPT
• Jai Swaminarayan Inc (QC Medical Group and Weight Loss)
• Tyler Michael Jakubowski
• Yoely B Jaramillo

• General Practice Dentistry in Moline, IL
• Providers in Moline, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.