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1235458514 NPI number — JESSE L JACKSON DDS

NPI Number: 1235458514
Health Care Provider/Practitioner: JESSE L JACKSON DDS

Information about “1235458514” NPI (JESSE L JACKSON DDS) exists in 1235458514 in HTML format HTML  |  1235458514 in plain Text format TXT  |  1235458514 in PDF (Portable Document Format) PDF  |  1235458514 in an XML format XML  formats.

NPI Number : 1235458514 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235458514",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "JESSE",
    "MiddleName": "L",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8650 NE SHOAL CREEK VALLEY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KANSAS CITY",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64157-8063",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-429-5799",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8650 NE SHOAL CREEK VALLEY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KANSAS CITY",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64157-8063",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-429-5799",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/25/2010",
    "LastUpdateDate": "11/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332BC3200X",
          "TaxonomyName": "Customized Equipment (DME)",
          "LicenseNumber": "2010016173",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "2010016173",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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