Earl W Jackson DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

5913 Issued in IN

Legal business name

EARL W JACKSON DDS INC

Practice address

3802 S Adams St
Marion, IN 46953

Phone

(765) 674-7935

Fax

(765) 677-1160

NPI assigned

Jun 28, 2006

Last updated

Sep 18, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Earl Wayne Jackson, DDS

Title

Dentist

Phone

(765) 674-7935

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190073600000",
    "number": "1669409058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3802 S ADAMS ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "46953",
            "telephone_number": "765-674-7935",
            "fax_number": "765-677-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 S ADAMS ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "46953",
            "telephone_number": "765-674-7935",
            "fax_number": "765-677-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARL W JACKSON DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-09-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "765-674-7935",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "5913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Marion, IN
• Providers in Marion, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2007; 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.