Ryne Jackson, DMD, MSD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D012024 Issued in AZ

Practice address

15294 W Brookside LN Ste 100
Surprise, AZ 85374-2446

Phone

(623) 376-7400

NPI assigned

Jun 24, 2019

Last updated

Jul 14, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Surprise Endo PLLC

  dba Surprise Endodontics

  • Endodontics
  • Surprise, AZ
  • NPI 1285432518
  NPD Authorized official
• Robinson Dental Group

  • General Practice Dentistry
  • Lake Charles, LA
  • NPI 1154628519

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1619538436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24125 N 160TH AVE",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853871629",
            "telephone_number": "480-353-6476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15294 W BROOKSIDE LN STE 100",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742446",
            "telephone_number": "623-376-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RYNE",
        "credential": "DMD, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-24",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "7005",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AZ",
            "license": "D012024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alina Hussein Jaafar, DMD
• Christopher Ladd Jackson, MC, LPC, LISAC, NCGC
• Jeremiah Rashad Jackson
• Kristin Jackson, EDS
• Melissa Jeree Jackson, LPC
• Hannah Jacobs, DOT
• Susan Andrea Jaffe, PT
• Kimberly Jager, FNP
• Emily Rose Jagodzinski
• Mark Andrew Jagodzinski, PT

• Endodontics in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Endodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.