NPIMap

Organization Active NPI

Brian E Jackson DDS LLC

  • Dentist
  • Willoughby Hills, OH
National Provider Identifier
1801349154
Registry record updated Aug 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BRIAN E JACKSON DDS LLC
Practice address
2775 Bishop Rd
Suite C
Willoughby Hills, OH 44092-2683
Phone
(440) 944-7775
NPI assigned
Aug 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2016

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

Authorized official

Name
Brian E JacksonNPI 1689665408
Title
Owner
Phone
(440) 944-7775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2775 Bishop Rd
Suite C
Willoughby Hills, OH 44092-2683

Mailing address

2775 Bishop Rd
Suite C
Willoughby Hills, OH 44092-2683
Phone (440) 944-7775

National Provider Directory

National Provider Directory

Locations

2775 Bishop Rd
Ste C
Willoughby Hills, OH 44092
Phone (440) 944-7775

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470700800000",
    "number": "1801349154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2775 BISHOP RD",
            "address_2": "SUITE C",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440922683",
            "telephone_number": "440-944-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 BISHOP RD",
            "address_2": "SUITE C",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440922683",
            "telephone_number": "440-944-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN E JACKSON DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-944-7775"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby Hills, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.