Pediatric Dentistry of Hamburg

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY OF HAMBURG

Practice address

2517 Sir Barton Way
Suite #200
Lexington, KY 40509-2275

Phone

(859) 543-2456

Fax

(859) 543-2373

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Rodney Allen Jackson, D.M.D.

Title

Pedodontist

Phone

(859) 543-2456

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790992220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2517 SIR BARTON WAY",
            "address_2": "SUITE #200",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092275",
            "telephone_number": "859-543-2456",
            "fax_number": "859-543-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2517 SIR BARTON WAY",
            "address_2": "SUITE #200",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405092275",
            "telephone_number": "859-543-2456",
            "fax_number": "859-543-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF HAMBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PEDODONTIST",
        "authorized_official_telephone_number": "859-543-2456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60004041",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002201",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Mook Pedersen, CSW
• Bailey Pedersen
• Pediatric & Adolescent Associates
• Pediatric & Adolescent Associates
• Pediatric and Adult Therapy Associates Incorporated
• Pediatric Orthotic and Prosthetic Services-Midwest, LLC
• Pediatric Specialty Clinic, LLC.
• Pediatrix Medical Group of Kentucky PSC
• Nicholas Pedicini
• Pedorthic Services, LLC

• Pediatric Dentistry in Lexington, KY
• Providers in Lexington, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.