JERRY JACK (NPI# 1265463467) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265463467 |
| Entity Type | Individual |
| Full Name | JERRY JACK |
| Credential | DDS |
| Practice Address |
1740 N Service Rd Moore OK 73160-3307 |
| Mailing Address |
555 W Benjamin Holt Dr Building B Stockton CA 95207-3839 |
| Practice Telephone | 4057947200 |
| Practice Fax Number | 4057942266 |
| Mailing Telephone | 2094764700 |
| Mailing Fax Number | 2094786890 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
3903 | OK | Dental Providers |
| Street Address |
1740 N SERVICE RD |
| City | MOORE |
| State | OK |
| Zip Code | 73160-3307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881636561 | Roger Potts Dental Group, PC | Dentist | 1740 N Service Rd, Moore, OK 73160-3307 | 2006-06-10 |
| 1659534857 | Ashley Coerver | Dentist | 1740 N Service Rd, Moore, OK 73160-3307 | 2008-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225678576 | Crystal Amanda Pitts | Student in an Organized Health Care Education/Training Program | 628 Allison Ln, Moore, OK 73160 | 2020-01-14 |
| 1982247623 | Tammie Lee Haworth | Occupational Therapy Assistant | Quest, 400 N Eastern Ave, Moore, OK 73160 | 2019-10-25 |
| 1477102580 | Php Management Group, LLC | Non-Pharmacy Dispensing Site | 1110 Magnolia Court, Moore, OK 73160 | 2019-09-11 |
| 1477117893 | Pharmology Moore LLC | Pharmacy | 1280 N Eastern Ave, Suite F, Moore, OK 73160 | 2019-05-01 |
| 1154891943 | Leah Cordell | Nurse Practitioner | 1280 North Eastern Ave., Suite F, Moore, OK 73160 | 2018-12-05 |
| 1467962332 | Healthcare Express, LLP | Clinic/Center | 551 Se 4th Street, Moore, OK 73160 | 2017-10-05 |
| 1306379557 | Dicarlo Venegas | Behavior Technician | 716 Wood Hollow Ln, Moore, OK 73160 | 2017-04-05 |
| 1073050167 | Tyron Dorrell Cosby Sr. | Case Manager/Care Coordinator | 1416 Penn Ln., Moore, OK 73160 | 2017-01-26 |
| 1326592650 | Kristin Kelley | Counselor | 1113 S Avery Dr, Moore, OK 73160 | 2016-08-03 |
| 1376912600 | Allison Kay Griffiths | Counselor | 9501 S. I-35 Service Rd, Apt 1504, Moore, OK 73160 | 2015-09-16 |
| Find all providers in zip 73160 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679183420 | Dentists of Moore and Orthodontics | Dentist | 740 Sw 19th St Ste C, Moore, OK 73160-3062 | 2020-08-06 |
| 1578056065 | Summer Dental Moore Pllc | Dentist | 811 Sw 19th St Ste A, Moore, OK 73160-2890 | 2018-06-11 |
| 1700303328 | James Prescott | Dentist | 1060 Sw 4th St Ste 200, Moore, OK 73160-2494 | 2017-08-24 |
| 1306186796 | Modern Dental Professionals - Oklahoma, PC | Dentist | 711 Sw 19th Street, Suite 100, Moore, OK 73160 | 2013-02-21 |
| 1386901403 | Yong Hong Dds Pllc | Dentist | 811 S.w. 19th St., Suite A, Moore, OK 73160-2802 | 2012-04-13 |
| 1003045469 | Leta Langford | Dentist | 2305 S I-35, Moore, OK 73160 | 2009-07-07 |
| 1831325570 | Dental Depot of Moore, Pllc | Dentist | 2709 S. I-35 Frontage Rd, Suite B, Moore, OK 73160 | 2009-06-09 |
| 1821263567 | Richard S. Homsey D.s.s. Inc | Dentist | 1400 S.e. 4th, Suite A, Moore, OK 73160 | 2008-04-24 |
| 1962677898 | George R. Safley D.d.s., Inc. | Dentist | 101 Ne 18th St, Moore, OK 73160-4601 | 2008-04-22 |
| 1467655068 | Brett Alan Leemaster | Dentist | 520 S Telephone Rd Ste 205, Moore, OK 73160-5425 | 2007-06-09 |
| Find all providers in MOORE | ||||
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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.