Active NPI
Maria O. Jackson, D.D.S.
- General Practice Dentistry
- Dallas, TX
National Provider Identifier
1811429905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 32785
- Practice address
- 5330 E Mockingbird LN Ste 120
Dallas, TX 75206-0941 - Phone
- (214) 821-5011
- NPI assigned
- Mar 29, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61175 | KS | |
| General Practice Dentistry | 1223G0001X | 32785 | TX | Primary |
Addresses
Primary practice location
5330 E Mockingbird LN Ste 120
Dallas, TX 75206-0941
Mailing address
1113 Sycamore Ridge Dr
Lansing, KS 66043-6314
Other practice location 1
1000 N Main St
Suite 5
Lansing, KS 66043-1304
Phone (816) 200-2676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32785 | TX | MD | Clinical Psychologist |
| 61175 | KS | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1811429905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1113 SYCAMORE RIDGE DR",
"city": "LANSING",
"state": "KS",
"postal_code": "660436314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5330 E MOCKINGBIRD LN STE 120",
"city": "DALLAS",
"state": "TX",
"postal_code": "752060941",
"telephone_number": "214-821-5011"
}
],
"practiceLocations": [
{
"address_1": "1000 N Main St",
"address_2": "Suite 5",
"address_purpose": "LOCATION",
"city": "Lansing",
"state": "KS",
"postal_code": "660431304",
"country_code": "US",
"telephone_number": "816-200-2676",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "MARIA",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-29",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "61175",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "32785",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.