Tracy Leslie Jackson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN0013214 Issued in FL

Practice address

1731 Manatee Ave E
Bradenton, FL 34208

Phone

(941) 749-5512

Fax

(941) 749-5826

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

Yes

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

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1740203496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 MANATEE AVE E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34208",
            "telephone_number": "941-749-5512",
            "fax_number": "941-749-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 MANATEE AVE E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "34208",
            "telephone_number": "941-749-5512",
            "fax_number": "941-749-5826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "middle_name": "LESLIE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN0013214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Jackson, MOTR/L
• Colton Jackson, D.O.
• Jaih C Jackson, DDS, PA
• Jessica Jackson, CNM
• Joshua Jackson, PHARM.D.
• Travis Jackson
• James Paul Jaco, M.ED.
• Jacob Joseph M.D., P.a.
• Aarcha Mary Jacob, APRN FNP
• Kimberly Lynn Jacobsen, MA LMHC

• General Practice Dentistry in Bradenton, FL
• Providers in Bradenton, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.