Kyle R. Jackson, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30-01-8976 Issued in OH

Practice address

273 Regency Ridge Dr
Centerville, OH 45459-4221

Phone

(937) 586-7729

Fax

(937) 660-4450

NPI assigned

Jan 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jackson Dental Group, LLC

  • Pediatric Dentistry
  • West Chester, OH
  • NPI 1184347452
  NPD Authorized official
• Kyle R. Jackson, DDS, LLC

  dba Keep Smiling Kids

  • Pediatric Dentistry
  • Beavercreek, OH
  • NPI 1710546437
  NPD Authorized official

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481155200000",
    "number": "1730159849",
    "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": "273 REGENCY RIDGE DR",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594221",
            "telephone_number": "937-586-7729",
            "fax_number": "937-660-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KYLE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2016-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30-01-8976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Clarke Sanders DDS-Centerville LLC (Centerville Family Dental)
• J. Kilby Enterprises, Inc. (Ellie Mental Health)
• Jack E. King DDS Inc (King and Mayerson Orthodontics)
• Jack M. Harless LLC
• Kyana L Jackson
• Courtney Nicole Jacobs, APRN
• Debra A Jacobs, CPNP-PC
• Denisa Despina Jacobs, RT (R)(CT), PA-C
• Haseeb Jafri, M.D.
• Sahar Jallaq, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; 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.