Active NPI
Bruce W Jackson, DDS
- Dentist
- Liberal, KS
National Provider Identifier
1851430532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5376
- Practice address
- 111 Lilac Dr
Liberal, KS 67901 - Phone
- (620) 624-0196
- Fax
- (620) 624-2443
- NPI assigned
- Feb 6, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5376 | KS | Primary |
Addresses
Primary practice location
111 Lilac Dr
Liberal, KS 67901
Mailing address
111 Lilac Dr
Liberal, KS 67901
Phone (620) 624-0196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5376 | Other | KS | KANSAS DENTAL BOARD |
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 |
|---|---|---|---|
| 5376 | KS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851430532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 LILAC DR",
"city": "LIBERAL",
"state": "KS",
"postal_code": "67901",
"telephone_number": "620-624-0196",
"fax_number": "620-624-2443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 LILAC DR",
"city": "LIBERAL",
"state": "KS",
"postal_code": "67901",
"telephone_number": "620-624-0196",
"fax_number": "620-624-2443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRUCE",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "5376",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KANSAS DENTAL BOARD",
"identifier": "5376",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Liberal, KS
- Ian F Yeats M.D. Chartered
- Zaki G Ibrahim, MD
- Timothy Wayne Ingram, HEARING SPECIALIST
- Rohitha Inturi, MD
- Elyse Ann Jablonski, PA-C
- Jean-Michel, Hassan, MD Southwest Clinic Inc (Southwest Clinic Inc)
- Julio Jimenez, D.C
- John a Buie, M.D. P.C.
- Rosemary Renata Juarez, PHARM D
- Jury, Farrar and Associates, Doctors of Optometry, PA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.