Organization Active NPI

State Street-Orthodontics LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hackensack, NJ
National Provider Identifier
1912852682
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
STATE STREET-ORTHODONTICS LLC
Practice address
405 Main St
Hackensack, NJ 07601-5965
Phone
(201) 487-7030
Fax
(201) 487-4418
NPI assigned
Feb 27, 2026
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Authorized official

Name
Dr. Edward Michael Jackson, DMDNPI 1477640373
Title
Owner
Phone
(201) 487-7030

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU Primary

Addresses

Primary practice location

405 Main St
Hackensack, NJ 07601-5965

Mailing address

405 Main St
Hackensack, NJ 07601-5965
Phone (201) 487-7030

National Provider Directory

National Provider Directory

Locations

405 Main St
Hackensack, NJ 07601
Phone (201) 487-7030

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1772150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1912852682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015965",
            "telephone_number": "201-487-7030",
            "fax_number": "201-487-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015965",
            "telephone_number": "201-487-7030",
            "fax_number": "201-487-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE STREET-ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-27",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-487-7030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; 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.