Jackson Fuller, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

39355 Issued in TX

Practice address

2600 Village Pkwy Ste 120
Highland Village, TX 75077-3285

Phone

(469) 444-6500

NPI assigned

Jul 15, 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

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 and National Provider Directory roles.

• Highland Dental Group, PLLC

  dba Highland Village Family Dentistry

  • Dental Clinic/Center
  • Highland Village, TX
  • NPI 1760291017
  NPD Authorized official

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1619549862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 VILLAGE PKWY STE 120",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 VILLAGE PKWY STE 120",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773285",
            "telephone_number": "469-444-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JACKSON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Flenning
• Fortitude Performance Physical Therapy, LLC
• Aline Beatrice Fosso, RN
• Stuart Donald Frith, D.C.
• Katherine Noelle Fulford, RN, MSN, AGNP-C
• Katia Alejandra Garza, DC
• Wilson Gin, L.AC., D. AC.
• Leigh Ashley Gistinger, CPNP
• Tiana Joy Gooden, LCSW
• Tommy Lee Gravley

• General Practice Dentistry in Highland Village, TX
• Providers in Highland Village, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.