Richard Edwin Jackson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2037 Issued in SC

Practice address

109 Timbermill Dr
Lexington, SC 29073-7138

Phone

(803) 957-2297

Fax

(803) 957-4178

NPI assigned

Jul 27, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in SC

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.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gentle Dentistry of Lexington, LLC

  • General Practice Dentistry
  • Lexington, SC
  • NPI 1114519717
  NPD (past)
• Gentle Dentistry of Lexington, LLC

  • General Practice Dentistry
  • Lexington, SC
  • NPI 1821589367
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801810163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 TIMBERMILL DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290737138",
            "telephone_number": "803-957-2297",
            "fax_number": "803-957-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 TIMBERMILL DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290737138",
            "telephone_number": "803-957-2297",
            "fax_number": "803-957-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "2037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Michelle Jackson
• Courtney Jackson, PHARMD
• Gwennetta Patrice Jackson, COTA
• James Benjamin Jackson III, MD
• Jessica M Jackson, PT
• Ronald Jackson, MSW
• Vander James
• Faith Jandrisevitz
• Megan Deloreto Jaramillo, MSR, CCC-SLP
• Michael T. Jauch, DMD

• General Practice Dentistry in Lexington, SC
• Providers in Lexington, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.