Lloyd Jackson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12005914A Issued in IN

Practice address

2100 E Lake Cook Rd
Suite 1100
Buffalo Grove, IL 60089-1999

Phone

(847) 580-5954

NPI assigned

Feb 26, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1780710582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "847-580-5954",
            "fax_number": "877-821-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E LAKE COOK RD",
            "address_2": "SUITE 1100",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600891999",
            "telephone_number": "847-580-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LLOYD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12005914A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100133890",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Ivanchenko, M.D.
• Katryn Ivashnev
• Aybek Izzatov, LMT
• J I Frank, MD, SC
• Bernadette Cadiz Jackson, DPT
• Jacob S Lake DDS LTD
• Dara S Jacobs, MS CCC-SLP
• Jacqueline G Rosen
• Divya Jain, PSY.D.
• Janet Preston Audiology LLC

• Dentist in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2012; 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.