Brian James Jackson, DDS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

6128 Issued in WA

Practice address

3924 Martin Way E
Olympia, WA 98506-5220

Phone

(360) 456-8610

Fax

(360) 493-8179

NPI assigned

Nov 14, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 16, 2016 through Jun 16, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223337600000",
    "number": "1770655979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3924 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065220",
            "telephone_number": "360-456-8610",
            "fax_number": "360-493-8179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3924 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065220",
            "telephone_number": "360-456-8610",
            "fax_number": "360-493-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRIAN",
        "middle_name": "JAMES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "WA",
            "license": "6128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5030374",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian A Iuliano, MD
• Chris Noel Iverson, LMP
• Adaugo Onyekachi Iwuchukwu
• J. Hyung Choi, DDS, P.C.
• Carla Jacks
• Nicole Kimberly Jackson, DO
• Tannalia Virginia Jackson
• Shalini Mary Jacob, M.D., MRCP, FACP
• William Chase Jacob, PHARMD
• Jayme Jean Jacobs

• Oral and Maxillofacial Pathology Dentistry in Olympia, WA
• Providers in Olympia, WA by specialty
• Oral and Maxillofacial Pathology Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.