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NPI Code Detail

MEDICARE: CENTERVILLE OH - KYLE JACKSON DDS INC

MEDICARE: CENTERVILLE OH - KYLE JACKSON DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1730032210
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTERVILLE OH - KYLE JACKSON DDS INC
Provider Business Mailing Address
First Line : 273 REGENCY RIDGE DR
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4221
Country : US
Telephone Number : 937-586-7729
Fax Number :
Provider Business Practice Location Address
First Line : 273 REGENCY RIDGE DR
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4221
Country : US
Telephone Number : 937-586-7729
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : MAGGI EVANS
Credential :
Telephone Number : 720-603-4800
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Practice Location Address:
273 REGENCY RIDGE DR
CENTERVILLE, OH
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Practice Phone: 937-586-7729
Practice Fax: 937-660-4450
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Practice Fax:
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1003379272 — DR. MEGAN CARY TIGANI DDS
Practice Location Address:
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Practice Fax:

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