Richard L. Jackson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17359 Issued in OH

Practice address

3650 Erie Ave
Cincinnati, OH 45208-1928

Phone

(513) 321-3037

Fax

(513) 321-2071

NPI assigned

Apr 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richard L. Jackson, D.D.S., Inc.

  • Dentist
  • Cincinnati, OH
  • NPI 1003862913
  NPD (past) Authorized official
• Rachel C Bailey, DMD LLC

  • Dentist
  • Cincinnati, OH
  • NPI 1720879398
  NPD (past)

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972626422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 ERIE AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452081928",
            "telephone_number": "513-321-3037",
            "fax_number": "513-321-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 ERIE AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452081928",
            "telephone_number": "513-321-3037",
            "fax_number": "513-321-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "17359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nia Jackson
• Pateeser A Jackson
• Patricia A. Jackson, R.N.
• Randy Jackson
• Raymond William Jackson, MD
• Ronald L Jackson Sr., ED.D.
• Samantha Jackson
• Samantha L Jackson
• Scott M Jackson
• Sentell Jackson

• General Practice Dentistry in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.