DR. WALTER CHARLES JACKSON (NPI# 1255507588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255507588 |
| Entity Type | Individual |
| Full Name | DR. WALTER CHARLES JACKSON |
| Credential | DDS, MD |
| Practice Address |
4051 Veterans Memorial Blvd Suite 200 Metairie LA 70002-5572 |
| Mailing Address |
4051 Veterans Memorial Blvd Ste 200 Metairie LA 70002-5567 |
| Practice Telephone | 5044557161 |
| Practice Fax Number | 5044557162 |
| Mailing Telephone | 5044557161 |
| Mailing Fax Number | 5044557162 |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2009-06-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
5927 | LA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184117814 | Walter L Jackson | Psychologist | 256 Eliot St, Natick, MA 01760-5513 | 2018-06-07 |
| 1902982796 | Walter Osborne Jackson | Emergency Medicine | 10329 Greenoak Blvd, Fort Wayne, IN 46814-9546 | 2006-10-27 |
| Street Address |
4051 VETERANS MEMORIAL BLVD SUITE 200 |
| City | METAIRIE |
| State | LA |
| Zip Code | 70002-5572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174626428 | David M. Arrington | Dentist | 4051 Veterans Memorial Blvd, Suite 200, Metairie, LA 70002-5572 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114541737 | Solstice Technologies, Inc. | Clinical Medical Laboratory | 3501 Severn Ave Suite 24, Metairie, LA 70002 | 2020-05-29 |
| 1891335071 | Kristin Alongi | Nurse Practitioner | 3838 N Causeway Blvd. Ste 2200, Metairie, LA 70002 | 2020-01-15 |
| 1841850450 | Emily Suarez Tan | Dentist | 3301 Veterans Blvd., Suite 203, Metairie, LA 70002 | 2019-06-17 |
| 1902369317 | Unitedhealthcare of Louisiana, Inc. | Health Maintenance Organization | 3838 N. Causeway Blvd., Suite 2600, Metairie, LA 70002 | 2019-04-11 |
| 1013479195 | Jeffrey Scott Toler | Dentist | 2937 Veterans Memorial Blvd, Ste C, Metairie, LA 70002 | 2019-04-05 |
| 1982188470 | Kelly Brooke Anderson | Clinic/Center | 2215 Veterans Blvd, Metairie, LA 70002 | 2018-09-20 |
| 1831695253 | A&g Pediatrics LLC | Community Based Residential Treatment Facility, Mental Illness | 3001 Division St., Suite 206, Metairie, LA 70002 | 2018-04-04 |
| 1730691064 | Desire Care, LLC | Technician | 2800 Hessmer Ave, Suite B, Metairie, LA 70002 | 2017-10-26 |
| 1104338458 | Monet Wiltz | Case Manager/Care Coordinator | 2637 Edenborn Ave Ste 302, Metairie, LA 70002 | 2017-10-26 |
| 1316461395 | Crystal Mc Bride | Counselor | 3100 Ridgelake Dr. Suite 309, Metairie, LA 70002 | 2017-08-01 |
| Find all providers in zip 70002 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598123978 | Oral Surgery Services, LLC | Dentist | 4420 Conlin St, Suite 203, Metairie, LA 70006-2167 | 2016-02-01 |
| 1619209939 | Daniel Marshall Cummins | Dentist | 4224 Houma Blvd, Suite 670, Metairie, LA 70006-2933 | 2010-02-11 |
| 1245312834 | Robert Edward Lane | Dentist | 4224 Houma Blvd, Suite 230, Metairie, LA 70006-2933 | 2006-10-20 |
| 1306940556 | Demarcus D Smith Iv | Dentist | 4420 Conlin St, Suite 203, Metairie, LA 70006 | 2006-09-09 |
| 1184727505 | Paul J Walters | Dentist | 4420 Conlin St, Suite 203, Metairie, CA 70006 | 2006-09-07 |
| 1902908031 | John N Kent Jr. | Dentist | 3800 Houma Blvd, Suite 305, Metairie, LA 70006-4182 | 2006-09-01 |
| 1720180854 | Michael S Block | Dentist | 110 Veterans Memorial Blvd, Ste 112, Metairie, LA 70005 | 2006-09-01 |
| 1639271760 | Jon D Perenack | Dentist | 3800 Houma Blvd, Ste 305, Metairie, LA 70006-4182 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868676 | Cypress Bend Oral & Maxillofacial Surgery | Dentist | 106 Rue Bastille, Lafayette, LA 70508 | 2020-07-13 |
| 1578089603 | Ardoin-kennedy LLC | Dentist | 203 A Energy Parkway, Lafayette, LA 70508 | 2017-08-21 |
| 1932583358 | Oral Surgery& Dental Implant Center of Louisiana | Dentist | 16206 Airline Hwy, Prairieville, LA 70769-4248 | 2015-07-15 |
| 1588078224 | Ricardo Lugo | Dentist | 1501 Kings Hwy Rm 530, Shreveport, LA 71103-4228 | 2014-06-19 |
| 1184059818 | Yasser Saad Alali | Dentist | 5243 Butter Creek, Unit H7, Baton Rouge, LA 70809-0603 | 2013-09-12 |
| 1679913222 | Nickolas Stanley Maskas | Dentist | 4720 Lake Street, Lake Charles, LA 70605 | 2013-06-27 |
| 1720354822 | John Ben Ragusa | Dentist | 16819 Cherry Bark Dr, Baton Rouge, LA 70810-5811 | 2012-03-22 |
| 1871882480 | Andrew Frederick Wetterlind | Dentist | 13730 Millerville Greens Blvd, Baton Rouge, LA 70816-1696 | 2011-04-04 |
| 1932415007 | Dr. David M. Vieth Dds, A Professional Corporation | Dentist | 91 Westbank Expy, Suite 345, Gretna, LA 70053-3615 | 2010-08-26 |
| 1871757187 | George Rawleigh Fisher | Dentist | 1624 Wolf Cir, Lake Charles, LA 70605 | 2008-07-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.