NPIMap

Organization Active NPI

Jackson Dental, LLC

  • General Practice Dentistry
  • Jackson, MO
National Provider Identifier
1932260338
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
013049 Issued in MO
Legal business name
JACKSON DENTAL, LLC
Practice address
3100 E Jackson Blvd
Jackson, MO 63755-2957
Phone
(573) 243-5200
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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

Authorized official

Name
Kay Lynn Welker
Title
Office Administrator
Phone
(573) 243-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 013049 MO Primary

Addresses

Primary practice location

3100 E Jackson Blvd
Jackson, MO 63755-2957

Mailing address

3100 E Jackson Blvd
Jackson, MO 63755-2957
Phone (573) 243-5200

National Provider Directory

National Provider Directory

Locations

3100 E Jackson Blvd
Jackson, MO 63755
Phone (573) 243-1520

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1932260338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 E JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552957",
            "telephone_number": "573-243-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 E JACKSON BLVD",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637552957",
            "telephone_number": "573-243-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-05-18",
        "status": "A",
        "authorized_official_last_name": "WELKER",
        "authorized_official_first_name": "KAY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "573-243-5200"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "013049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; 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.