Brandi R. Jackson DDS, Ms, PLLC

Key facts

NPI

1881975191

Entity type

Organization (NPI type 2)

Primary specialty

Dentist 122300000X

License

8224 (NC)

Legal business name

BRANDI R. JACKSON DDS, MS, PLLC

Practice address

11223 Davinci Dr
Davidson, NC 28036-7799

Phone

(704) 895-6445

Fax

(704) 895-6496

NPI assigned

Aug 31, 2011

Organization subpart

No

Authorized official

Name

Dr. Brandi R Jackson, DDS, MS NPI 1912186321

Title

Owner/Dentist

Phone

(704) 895-6445

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandi Rochelle Jackson, DDS Pediatric Dentistry · Davidson, NC · NPI 1912186321
  NPD (past) Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• Northeast Pediatric Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 31, 2011.

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314748800000",
    "number": "1881975191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11223 DAVINCI DR",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280367799",
            "telephone_number": "704-895-6445",
            "fax_number": "704-895-6496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11223 DAVINCI DR",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280367799",
            "telephone_number": "704-895-6445",
            "fax_number": "704-895-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDI R. JACKSON DDS, MS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-08-31",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "704-895-6445",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "8224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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