JACKIE JANZEN (NPI# 1295368918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295368918 |
| Entity Type | Individual |
| Full Name | JACKIE JANZEN |
| Practice Address |
1430 John Wesley Gilbert Drive Augusta GA 30912-0001 |
| Mailing Address |
1454 Waccamaw Dr North Augusta SC 29841-2023 |
| Practice Telephone | 7067212371 |
| Mailing Telephone | 6787634829 |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2020-07-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DN016095 | GA | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1430 JOHN WESLEY GILBERT DRIVE |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30912-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811978927 | Andrew Robert Kious | Dentist | 1430 John Wesley Gilbert Drive, Ghsu College of Dental Medicine, Augusta, GA 30912 | 2005-11-07 |
| 1801421268 | Cassandra Nicole Liston | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-03-05 |
| 1710511738 | Amara Altman | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Dental College of Georgia, Augusta, GA 30909 | 2020-02-28 |
| 1316571318 | Macy Malcom Copelan | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-02-27 |
| 1447884770 | Shane Mitchell Turgeon | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2020-02-25 |
| 1275195984 | Anh Nguyen | Dentist | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-5042 | 2019-07-02 |
| 1508328824 | Skylar Yearous | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, College of Dental Medicine Pedodontics - Gc 2116, Augusta, GA 30901 | 2019-04-04 |
| 1659832657 | Mahmoud Elashiry | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2019-03-31 |
| 1942761267 | Eric Hatten | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2019-03-28 |
| 1063973477 | Fatin Jweinat | Student in an Organized Health Care Education/Training Program | 1430 John Wesley Gilbert Drive, Augusta, GA 30912-0001 | 2019-03-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548885940 | Hannah Gullickson Folsom | Family Medicine | 1459 Laney Walker Blvd Ae 3042, Augusta, GA 30912 | 2020-06-11 |
| 1487278909 | Robert Kennedy | Internal Medicine | Augusta University Internal Medicine Residency Program, 1120 15th Street, Bi 5070, Augusta, GA 30912 | 2020-06-01 |
| 1952968737 | Kayla M. Lasota | Pediatrics | 11230 115th St Ae3042, Augusta, GA 30912 | 2019-05-28 |
| 1003379280 | Kayla Cox | Internal Medicine | 1120 15th St Bi5070, Augusta, GA 30912 | 2019-04-13 |
| 1619435740 | Justin Ray Mackert | Student in an Organized Health Care Education/Training Program | Augusta University, 1120 15th Street, Gc 5110, Augusta, GA 30912 | 2019-03-07 |
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1487157921 | Julie Ann Matsen | Student in an Organized Health Care Education/Training Program | 997 St. Sebastian Way, Eg-2021-10, Augusta Univ., Dept. of Psychiatry & Health Behavior, Augusta, GA 30912 | 2018-03-12 |
| 1497287031 | Luke Yuung-jier Chang | Ophthalmology | 1120 15th St # Ba2720, Augusta, GA 30912 | 2017-04-02 |
| 1821537622 | Lashawn Kay Boone | Nurse Practitioner | 1445 Harper St, Augusta, GA 30912 | 2017-02-14 |
| 1134675564 | Arnab Saha | Internal Medicine | 1120 15 Th St., Augusta, GA 30912 | 2016-08-26 |
| Find all providers in zip 30912 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417444167 | Victor Celis | Dentist | John Wesley Gilbert Dr, Augusta, GA 30912 | 2018-04-18 |
| 1356848022 | Olubusola Olaoluwa Olaseinde | Dentist | 2122 Swindon Dr, Augusta, GA 30909-6912 | 2018-04-10 |
| 1992172407 | Jeremy Richard Edwards | Dentist | 3208 Crane Ferry Rd, Augusta, GA 30907-3771 | 2015-09-01 |
| 1346616810 | Michael Shane Baura | Dentist | 1 Freedom Way # 233u, Augusta, GA 30904-6258 | 2015-08-19 |
| 1972912301 | Matthew Lee Andrews | Dentist | The Dental College of Georgia 1120 15th Street Gc 5110, Augusta, GA 30912-0001 | 2014-08-11 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1558797761 | One Smile Away Inc | Dentist | 4159 Elders Dr, Augusta, GA 30909-9145 | 2013-09-19 |
| 1285986067 | Tanya Lynn Shores | Dentist | 1210 Geore C. Wilson Dr., Augusta, GA 30909-4501 | 2012-10-04 |
| 1073864963 | Matthew Ross Anderson | Dentist | 1120 15th St # Gc5110, Augusta, GA 30912-0004 | 2012-10-02 |
| 1699099853 | Eric J Sterett | Dentist | 2437 Lumpkin Rd, Augusta, GA 30906-3000 | 2010-03-17 |
| Find all providers in AUGUSTA | ||||
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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.