Nicole Jackson, DDS, a Professional Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

NICOLE JACKSON, DDS, A PROFESSIONAL DENTAL CORPORATION

Practice address

5207 Pinnacle Pkwy
Covington, LA 70433-9191

Phone

(985) 893-4882

Fax

(985) 893-4884

NPI assigned

Feb 18, 2020

Organization subpart

No

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

Authorized official

Name

Nicole Jackson, DDS

Title

Owner

Phone

(985) 893-4882

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1861025868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5207 PINNACLE PKWY",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704339191",
            "telephone_number": "985-893-4882",
            "fax_number": "985-893-4884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5207 PINNACLE PKWY",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704339191",
            "telephone_number": "985-893-4882",
            "fax_number": "985-893-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE JACKSON, DDS, A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-893-4882",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Covington, LA
• Providers in Covington, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; 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.