Brandon Joshua Jackson, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

056966-1 Issued in NY

Practice address

70 Virginia Ave
Staten Island, NY 10305-1748

Phone

(718) 226-8851

NPI assigned

Jun 5, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Interoperability endpoints

• Direct secure messaging: brandon.jacksondds.p1@direct.ezramedical.nextgenshare.com

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.

• Dr Brandon Jackson Pediatric Dental PLLC

  • Pediatric Dentistry
  • Staten Island, NY
  • NPI 1629789722
  NPD Authorized official

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442275200000",
    "number": "1861753949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 VIRGINIA AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10305",
            "telephone_number": "917-626-3507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 VIRGINIA AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103051748",
            "telephone_number": "718-226-8851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDON",
        "middle_name": "JOSHUA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-05",
        "last_updated": "2015-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056966-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390200000X",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eve Jachniewicz, D.D.S
• Jack a. Mailman, DDS, Leonard I. Flug, DDS, P.C.
• Jack Basil Dangelo Jr
• Jack Miceli DDS PC
• Ann M Jackman, D.D.S.
• Dana Jackson, M.S.
• Jill Jackson, LPN
• Keith Ryan Jackson, M.D.
• Kelly A Jackson, OTR/L
• Rebecca Sabrina Jackson, CRPA

• Pediatric Dentistry in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.