Stephanie Lynn Jackson, DDS, MS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8412 Issued in NC

Practice address

13521 Steelecroft Pkwy
Suite 100
Charlotte, NC 28278-7545

Phone

(704) 714-5380

Fax

(704) 714-5380

NPI assigned

Jul 17, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Pediatric Dentistry of Steele Creek

  • Dentist
  • Charlotte, NC
  • NPI 1568624344
  NPD (past)

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285804800000",
    "number": "1992904155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13521 STEELECROFT PKWY",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787545",
            "telephone_number": "704-714-5380",
            "fax_number": "704-714-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13521 STEELECROFT PKWY",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282787545",
            "telephone_number": "704-714-5380",
            "fax_number": "704-714-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-17",
        "last_updated": "2010-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911548",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Jackson
• Rosemary Helen Jackson, PH.D.
• Shatamra Jackson, MSW
• Shelia Yvonne Jackson, LCSW-A
• Shonta Jackson
• Steven Howard Jackson, D.C.
• Tara Michele Jackson, MA, CCC-SLP
• Te'Essence Jackson
• Tiffany Jackson, FNP-C
• Tiffany Renae Jackson, FNP

• General Practice Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.