Keith Daniel Jackson, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401415969 Issued in VA

Practice address

244 Hydraulic Ridge Rd
Charlottesville, VA 22901-8124

Phone

(434) 973-3348

Fax

(434) 977-5790

NPI assigned

Jul 23, 2013

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 19, 2021 through Apr 19, 2027

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 and National Provider Directory roles.

• Central Virginia Oral & Facial Surgeons, PLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Charlottesville, VA
  • NPI 1336167006
  NPD (past)

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1871935569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 HYDRAULIC RIDGE RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229018124",
            "telephone_number": "434-973-3348",
            "fax_number": "434-977-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 HYDRAULIC RIDGE RD",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229018124",
            "telephone_number": "434-973-3348",
            "fax_number": "434-977-5790"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Sunset Ln",
            "address_purpose": "LOCATION",
            "city": "Culpeper",
            "state": "VA",
            "postal_code": "227013300",
            "country_code": "US",
            "telephone_number": "540-825-3069",
            "fax_number": "540-825-7429",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KEITH",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-23",
        "last_updated": "2024-03-26",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401415969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaelyn Taylor Jackson
• James C Jackson, LPC
• Katherine Thompson Jackson, M.DIV.
• Katrina E Jackson, LSA, CSFA
• Kayla Jackson, LCSW
• Mackenzie Jackson
• Mary A Jackson, LCSW
• Mary Jane Jackson, R.N., N.P.
• Megan Jackson, DC
• Nina Jackson, PT

• Oral and Maxillofacial Surgery (Dentist) in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.