Kyle R. Jackson, DDS, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KYLE R. JACKSON, DDS, LLC

Doing business as

Keep Smiling Kids

Practice address

4090 Indian Ripple Rd Unit 102
Beavercreek, OH 45440-3253

Phone

(937) 586-7729

Fax

(937) 490-9904

NPI assigned

Jun 6, 2019

Organization subpart

No

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

Authorized official

Name

Kyle R. Jackson, DDSNPI 1730159849

Title

Owner

Phone

(937) 586-7729

Specialties & licenses 1

Addresses

Other names 1

• Keep Smiling Kids Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle R. Jackson, DDS

  • Pediatric Dentistry
  • Centerville, OH
  • NPI 1730159849
  NPD Authorized official

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559779200000",
    "number": "1710546437",
    "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",
            "fax_number": "937-660-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4090 INDIAN RIPPLE RD UNIT 102",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454403253",
            "telephone_number": "937-586-7729",
            "fax_number": "937-490-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYLE R. JACKSON, DDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-586-7729",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keep Smiling Kids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lori Beth Kuli, PHARMD
• Johanna Grace Kultys
• Nikhil Tej Kurapati, MD, MPH
• Alisha Kusan, BCBA
• Tracey Kwiat, PAC
• Laboratory Corporation of America Holdings
• Courtney N Laczko, PA-C
• Lucis Ladden, PA-C
• Kimberly Lade
• Michaela Lamar, SLP

• Pediatric Dentistry in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; 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.