J. Andrew Jackson, D.D.S. LTD., LLP

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

14522 Issued in TX

Legal business name

J. ANDREW JACKSON, D.D.S. LTD., LLP

Practice address

600 Division, Suite E.
San Antonio, TX 78214

Phone

(210) 924-4279

Fax

(210) 924-4270

NPI assigned

Feb 12, 2010

Organization subpart

No

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

Authorized official

Name

Misty Adamitz

Title

Office MGR.

Phone

(210) 924-4279

Specialties & licenses 1

Addresses

Other identifiers 4

Practitioners 1

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

• John Andrew Jackson, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • San Antonio, TX
  • NPI 1720162779
  NPD (past)

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1962734160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 DIVISION, SUITE E.",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78214",
            "telephone_number": "210-924-4279",
            "fax_number": "210-924-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 DIVISION, SUITE E.",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78214",
            "telephone_number": "210-924-4279",
            "fax_number": "210-924-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. ANDREW JACKSON, D.D.S. LTD., LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "ADAMITZ",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "OFFICE MGR.",
        "authorized_official_telephone_number": "210-924-4279"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "14522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PMI DELTA CARE",
            "identifier": "651906",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "784161",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "56539501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306300-05",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.