Scott Christian Jackson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12245 Issued in TN

Practice address

5180 Park Ave Ste 210
Memphis, TN 38119-3530

Phone

(901) 763-0850

NPI assigned

Apr 16, 2022

Sex

Male

Sole proprietor

No

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

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.

• Dentalworks, Dr. Dietz & Associates (Park Avenue), P.C.

  • General Practice Dentistry
  • Memphis, TN
  • NPI 1023088523
  NPD (past)

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

{
    "created_epoch": "1650067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1669115770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17649 ROCKWOOD ARBOR DR",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630254035",
            "telephone_number": "636-236-3714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5180 PARK AVE STE 210",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193530",
            "telephone_number": "901-763-0850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "875 Union Ave Ste C211",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033513",
            "country_code": "US",
            "telephone_number": "901-448-6930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2059 S Houston Levee Rd Ste 126",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381396970",
            "country_code": "US",
            "telephone_number": "901-425-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SCOTT",
        "middle_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-16",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela A Jackson
• Rasheedah Jackson
• Regina Rodgers Jackson, FNP
• Ricky Jackson
• Ruth Jackson, APN
• Shandrika Jackson, RN
• Shironda D Jackson, LBSW
• Tammara Jackson, DPT
• Tasheka L Jackson
• Tennye R Jackson, MD

• General Practice Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; 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.