Jackson Robert Booth, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

23496 Issued in TX

Practice address

4410 E Riverside Dr
Suite 150
Austin, TX 78741-4799

Phone

(512) 739-9440

Fax

(512) 389-9797

NPI assigned

Aug 17, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392681600000",
    "number": "1891987368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 E RIVERSIDE DR",
            "address_2": "SUITE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787414799",
            "telephone_number": "512-739-9440",
            "fax_number": "512-389-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 E RIVERSIDE DR",
            "address_2": "SUITE 150",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787414799",
            "telephone_number": "512-739-9440",
            "fax_number": "512-389-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "JACKSON",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-17",
        "last_updated": "2014-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "23496",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9554",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sutiluck Boonsrisart
• Jeffrey Michael Boos, M.D.
• Katherine Elizabeth Boos, N.P.
• Boost Babies
• Heidi S Booth, CNS
• Justin Henry Booth, M.D.
• Margot Booth, LCSW
• Rachel Michelle Annette Booth, RBT
• Stephanie Ann Booth, M.D.
• Steven Leslie Booth, DDS

• General Practice Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; 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.