Glenn D Jackson, DMD
Individual provider Active NPI General Practice Dentistry · Maynard, MA
NPI 1922028356 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1922028356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 14629 (MA)
- Practice address
- 9 Nason St
Maynard, MA 01754 - Phone
- (978) 847-9407
- Fax
- (978) 897-3764
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151112001189 | MA | Order and Referring Only - Dentist |
6608186143 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14629 | MA | Yes |
Addresses
Primary practice location
9 Nason St
Maynard, MA 01754
Mailing address
9 Nason St
Maynard, MA 01754
Phone (978) 847-9407
Other providers in Maynard, MA
- Debora Hobbs
- Audrey Hockman
- Jeannine Ann Hughes
- Leigh-Anne Husted
- Inner Peace Nutrition Counseling
- Parker Thomas Johnson
- Linda Bradford Jones
- Linda Karcher
- Soman Karimi
- Julia Kates
All providers in Maynard, MA · General Practice Dentistry in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.