Kenneth J. Jackson D.D.S., Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20856 Issued in OH

Legal business name

KENNETH J. JACKSON D.D.S., INC.

Practice address

809 Redskin TRL
Wapakoneta, OH 45895-8546

Phone

(419) 738-2426

NPI assigned

Apr 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth J Jackson

Title

President

Phone

(419) 738-2426

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1902070998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 REDSKIN TRL",
            "city": "WAPAKONETA",
            "state": "OH",
            "postal_code": "458958546",
            "telephone_number": "419-738-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 REDSKIN TRL",
            "city": "WAPAKONETA",
            "state": "OH",
            "postal_code": "458958546",
            "telephone_number": "419-738-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH J. JACKSON D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "419-738-2426",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "20856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Wapakoneta, OH
• Providers in Wapakoneta, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.