Jackson Boulevard Dental Associates

Primary specialty

DentistTaxonomy code 122300000X

License

M636 Issued in SD

Legal business name

JACKSON BOULEVARD DENTAL ASSOCIATES

Doing business as

Taylor Dental

Practice address

2620 Jackson Blvd
Suite B
Rapid City, SD 57702-1502

Phone

(605) 348-1712

Fax

(605) 716-7529

NPI assigned

Jan 7, 2013

Organization subpart

No

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

Authorized official

Name

Jared L Taylor, DMD

Title

Owner

Phone

(605) 348-1712

Specialties & licenses 2

Addresses

Other names 1

• Taylor Dental Doing business as

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

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1629315932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 JACKSON BLVD",
            "address_2": "SUITE B",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577021502",
            "telephone_number": "605-348-1712",
            "fax_number": "605-716-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 JACKSON BLVD",
            "address_2": "SUITE B",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577021502",
            "telephone_number": "605-348-1712",
            "fax_number": "605-716-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON BOULEVARD DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-348-1712",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SD",
            "license": "M636",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "SD",
            "license": "D1002",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taylor Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chelsea Lynn Iversen, CNM
• Beth A Iverson, CNP
• Tom Dale Iverson, RPH
• J R Anesthesia Prof LLC
• Wanda Jaasund
• Brittany Ann Jackson Grueb, D.C.
• Emily Jackson, LAC
• Sheryl Jane Jackson, CNP
• Jacob Folstrom Counseling Services LLC
• Cindy C Jacobs, MEDICAL TECHNOLOGIST

• Dentist in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Dentist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.