Tanisha A Jackson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

47103 Issued in CA

Practice address

2860 Michelle
2ND Floor
Irvine, CA 92606-1009

Phone

(714) 508-3600

Fax

(714) 368-2092

NPI assigned

Aug 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Enrolled in CA

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

Medicare enrollment (NPD)

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.

• Jackson and Moore Professional Corporation

  dba Hub Plaza Dental Group

  • General Practice Dentistry
  • San Bernardino, CA
  • NPI 1841396637
  Authorized official Same address or phone
• Jackson Dental Corporation

  dba Redlands Dental Group

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Redlands, CA
  • NPI 1992899777

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629183777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 ORANGE ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923743206",
            "telephone_number": "909-792-7500",
            "fax_number": "909-792-7503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TANISHA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "47103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candace Lynn Jackson, MD
• Crystal Rene Jackson
• Daniel Jackson
• Gabrielle Marie Jackson, M.S., BCBA
• Michaela Jackson, PA-C
• Jacob K Ahdoot MD Inc
• Jacob Mathias Paredes Chiropractic Corp
• Isabella Mae Jacob
• Rachel Fe Jacob
• Maritza Jacobo

• General Practice Dentistry in Irvine, CA
• Providers in Irvine, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.