Active NPI
Charles B Jackson, Jr., DDS, MSD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Sandy, UT
National Provider Identifier
1972563690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 142729-9921
- Practice address
- 669 Union SQ
Sandy, UT 84070-3404 - Phone
- (801) 571-1231
- Fax
- (801) 571-9738
- NPI assigned
- Mar 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 142729-9921 | UT | Primary |
Addresses
Primary practice location
669 Union SQ
Sandy, UT 84070-3404
Mailing address
669 Union SQ
Sandy, UT 84070-3404
Phone (801) 571-1231
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142729-9921 | UT | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1972563690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "669 UNION SQ",
"city": "SANDY",
"state": "UT",
"postal_code": "840703404",
"telephone_number": "801-571-1231",
"fax_number": "801-571-9738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "669 UNION SQ",
"city": "SANDY",
"state": "UT",
"postal_code": "840703404",
"telephone_number": "801-571-1231",
"fax_number": "801-571-9738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON, JR.",
"first_name": "CHARLES",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-25",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "UT",
"license": "142729-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.