NPI Number: 1689762569
Health Care Provider/Practitioner: RICHARD F. JACKSON, DDS, GREGORY HEISE, DDS, AND CRAIG ALPHA, DDS
Information about “1689762569” NPI (RICHARD F. JACKSON, DDS, GREGORY HEISE, DDS, AND CRAIG ALPHA, DDS)
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<NPI>
1689762569
</NPI>
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Organization
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<ReplacementNPI/>
<EIN/>
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<IsOrgSubpart>
N
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RICHARD F. JACKSON, DDS, GREGORY HEISE, DDS, AND CRAIG ALPHA, DDS
</OrgName>
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<FirstName/>
<MiddleName/>
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6
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<FirstLineMailingAddress>
2525 K ST
</FirstLineMailingAddress>
<SecondLineMailingAddress>
SUITE 101
</SecondLineMailingAddress>
<MailingAddressCityName>
SACRAMENTO
</MailingAddressCityName>
<MailingAddressStateName>
CA
</MailingAddressStateName>
<MailingAddressPostalCode>
95816-5114
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
916-442-1882
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber>
91-644-2303
</MailingAddressFaxNumber>
<FirstLinePracticeLocationAddress>
2525 K ST
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress>
SUITE 101
</SecondLinePracticeLocationAddress>
<PracticeLocationAddressCityName>
SACRAMENTO
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
CA
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
95816-5114
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
916-442-1882
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber>
91-644-2303
</PracticeLocationAddressFaxNumber>
<EnumerationDate>
10/10/2006
</EnumerationDate>
<LastUpdateDate>
11/26/2012
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode/>
<Gender/>
<AuthorizedOfficialLastName>
JACKSON
</AuthorizedOfficialLastName>
<AuthorizedOfficialFirstName>
MARGARET
</AuthorizedOfficialFirstName>
<AuthorizedOfficialMiddleName/>
<AuthorizedOfficialTitle>
OFFICE ADMINISTRATOR
</AuthorizedOfficialTitle>
<AuthorizedOfficialNamePrefix>
MRS.
</AuthorizedOfficialNamePrefix>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential/>
<AuthorizedOfficialTelephoneNumber>
916-961-0570
</AuthorizedOfficialTelephoneNumber>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
1223S0112X
</TaxonomyCode>
<TaxonomyName>
Oral and Maxillofacial Surgery (Dentist)
</TaxonomyName>
<LicenseNumber>
24465
</LicenseNumber>
<LicenseNumberStateCode>
CA
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups>
<HealthcareProviderTaxonomyGroup>
<HealthcareProviderTaxonomyGroupName>
193400000X SINGLE SPECIALTY GROUP
</HealthcareProviderTaxonomyGroupName>
<HealthcareProviderTaxonomyGroupDescription>
Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
</HealthcareProviderTaxonomyGroupDescription>
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</Npi>
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