Shelby Ellis Jackson, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021.003305 Issued in IL

Practice address

6800 Main St
Downers Grove, IL 60516-3493

Phone

(630) 969-5350

NPI assigned

Oct 10, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brian M Caraba DDS PC

  • Dentist
  • Chicago, IL
  • NPI 1386864411
  NPD (past)

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1801677471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 N NORTH SHORE CT",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483623067",
            "telephone_number": "586-337-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 MAIN ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605163493",
            "telephone_number": "630-969-5350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7124 W Diversey Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "607071601",
            "country_code": "US",
            "telephone_number": "773-237-8855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHELBY",
        "middle_name": "ELLIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.034067",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021.003305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J G Dentistry, S. C.
• J Hart & Associates
• Jenna Jablonski
• Eric Jackson, D.D.S.
• Kendal'Spirit Jackson, LPC
• Kathleen Callaghan Jacob, L.C.S.W
• Laura L Jacobs, RDH
• Mark M Jacquot, O.D.
• Maliha Jamal Jaffery, MD
• Stephen Thomas Jagielo, DDS

• Orthodontics and Dentofacial Orthopedics Dentistry in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.