Active NPI
Paul Joseph Jackanich Jr., DDS
- Dentist
- Polano, OH
National Provider Identifier
1689622359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 18806
- Practice address
- 841 Southwestern Run
Ste 1
Polano, OH 44514 - Phone
- (330) 629-2270
- Fax
- (330) 629-2271
- NPI assigned
- May 5, 2006
- Last updated
- Jul 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 18806 | OH | Primary |
Addresses
Primary practice location
841 Southwestern Run
Ste 1
Polano, OH 44514
Mailing address
841 Southwestern Run
Ste 1
Poland, OH 44514-3688
Phone (330) 629-2270
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0754125 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150309001716 | OH | Order and Referring Only - Other (Physician) | 0244556355 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1689622359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "841 SOUTHWESTERN RUN",
"address_2": "STE 1",
"city": "POLAND",
"state": "OH",
"postal_code": "445143688",
"telephone_number": "330-629-2270",
"fax_number": "330-629-2271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "841 SOUTHWESTERN RUN",
"address_2": "STE 1",
"city": "POLANO",
"state": "OH",
"postal_code": "44514",
"telephone_number": "330-629-2270",
"fax_number": "330-629-2271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKANICH",
"first_name": "PAUL",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "18806",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0754125",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.