NPIMap

Organization Active NPI

Adventure Pediatric Dentistry of Centerville - DRS. Jackson and Mason

  • Pediatric Dentistry
  • Centerville, OH
National Provider Identifier
1710364369
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ADVENTURE PEDIATRIC DENTISTRY OF CENTERVILLE - DRS. JACKSON AND MASON
Practice address
273 Regency Ridge Dr
Centerville, OH 45459-4221
Phone
(937) 586-7729
NPI assigned
May 4, 2015
Last updated
May 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Authorized official

Name
Dr. Kyle R Jackson, DDSNPI 1730159849
Title
Partner
Phone
(937) 586-7729

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

273 Regency Ridge Dr
Centerville, OH 45459-4221

Mailing address

273 Regency Ridge Dr
Centerville, OH 45459-4221
Phone (937) 586-7729

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1710364369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 REGENCY RIDGE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594221",
            "telephone_number": "937-586-7729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 REGENCY RIDGE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594221",
            "telephone_number": "937-586-7729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTURE PEDIATRIC DENTISTRY OF CENTERVILLE - DRS. JACKSON AND MASON",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "937-586-7729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; 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.