CHARLES RUSSELL JACKSON (NPI# 1306929856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306929856 |
| Entity Type | Individual |
| Full Name | CHARLES RUSSELL JACKSON |
| Credential | DDS |
| Practice Address |
1 Med Center Dirve Morgantown WV 26506 |
| Practice Telephone | 3042932240 |
| Mailing Telephone | 3042932240 |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
2122 | WV | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896839 | Charles Jackson | Counselor | 2911 Penick St, Shreveport, LA 71109-4337 | 2016-12-21 |
| 1043655681 | Charles D Jackson | Driver | 4856 W.12th, Suite 1, Cleveland, OH 44109-3424 | 2013-05-09 |
| 1437594553 | Charles Jackson | Social Worker | 18712 Quarry St, Riverview, MI 48193-4527 | 2013-05-02 |
| 1508154105 | Charles Gilbert Jackson Jr. | Psychiatry & Neurology | 88 Crescent St, Northampton, MA 01060-2115 | 2011-07-16 |
| 1457669848 | Charles Edward Jackson Jr. | Psychologist | 1407 Healing Water Lane, N.las Vegas, NV 89031 | 2010-09-20 |
| 1588994081 | Charles Dustin Jackson | Counselor | 5004 Nw 26th St, Oklahoma City, OK 73127-1722 | 2010-01-05 |
| 1508985250 | Charles Arthur Jackson Jr. | Chiropractor | 2455 E Hill Rd, Grand Blanc, MI 48439 | 2007-03-27 |
| 1760535926 | Charles Jackson | Podiatrist | 820 N Dalmont St, Hobbs, NM 88240-5214 | 2007-01-19 |
| 1982769840 | Charles Jackson | Dentist | 3540 82nd St, Jackson Heights, NY 11372-5159 | 2006-12-22 |
| 1437224813 | Charles Wesley Jackson Jr. | Psychologist | 2980 Washington Blvd, Cleveland Heights, OH 44118-2450 | 2006-11-21 |
| Street Address |
1 MED CENTER DIRVE |
| City | MORGANTOWN |
| State | WV |
| Zip Code | 26506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124656491 | Lauren Bakos | Student in an Organized Health Care Education/Training Program | Department of Oral Surgery Room 1200 Hsc North, Morgantown, WV 26506 | 2020-03-31 |
| 1720613888 | Katharina Marie Mitchell | Student in an Organized Health Care Education/Training Program | Wvu Hospitals Ruby Memorial & Physician Office Center, 1 Medical Center Drive, Morgantown, WV 26506 | 2020-03-10 |
| 1811533961 | Hongyan Wu | Nurse Practitioner | Neurology Clinic, Wvu Eye Institute, 1 Medical Center Drive, Morgantown, WV 26506 | 2019-11-25 |
| 1871054569 | Brandon Chase Neeley | Student in an Organized Health Care Education/Training Program | 1 Stadium Dr Fl 3 Eye Institute, Morgantown, WV 26506 | 2019-03-26 |
| 1588125223 | Temitope Michael Kehinde | Student in an Organized Health Care Education/Training Program | 64 Medical Center Drive 2305hscn, Morgantown, WV 26506 | 2019-03-26 |
| 1417412743 | West Virginia University Hospitals, Inc. | Substance Abuse Rehabilitation Facility | 751 Benefactor Drive, Morgantown, WV 26506 | 2019-01-31 |
| 1932603024 | Emma Bacharach | Student in an Organized Health Care Education/Training Program | J.w. Ruby Memorial Hospital, 1 Medical Center Drive, Morgantown, WV 26506 | 2018-03-22 |
| 1982108270 | Qaisar Syed | Student in an Organized Health Care Education/Training Program | Wvu Medicine Anesthesiology, 1 Medical Center Drive, Morgantown, WV 26506 | 2018-03-21 |
| 1417451063 | Michael Savilla | Student in an Organized Health Care Education/Training Program | Wvu Medicine Anesthesiology, 1 Medical Center Drive, Morgantown, WV 26506 | 2018-03-20 |
| 1194255620 | William Black | Dentist | Room 1200 Hsc North, P.o. Box 9475, Morgantown, WV 26506 | 2017-06-18 |
| Find all providers in zip 26506 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992297733 | Jeffrey G Minchau Dds Ms | Dentist | 9000 Coombs Farm Dr, Ste 304, Morgantown, WV 26508 | 2018-06-06 |
| 1578728457 | Lauren Pectyo Namsupak | Dentist | 3412 University Ave, Morgantown, WV 26505-7220 | 2008-07-21 |
| 1174721393 | Kent Alexander Mcbride | Dentist | 2401 Cranberry Sq, Morgantown, WV 26508-9209 | 2007-07-10 |
| 1689895815 | Jeffrey Gary Minchau | Dentist | 2401 Cranberry Square, Morgantown, WV 26508 | 2007-05-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871085787 | Jeffrey G. Minchau, Dds, Ms, Inc. | Dentist | 2601 Dudley Avenue, Bldg. 1, Parkersburg, WV 26101 | 2018-06-06 |
| 1164710562 | Ernest Stephen Fragale | Dentist | 405 Capitol St Ste 914, Charleston, WV 25301-1744 | 2011-07-19 |
| 1073780284 | Michael Blaine Loftis | Dentist | 225 College Pkwy, Suite 103, Parkersburg, WV 26104-7655 | 2008-05-15 |
| 1104091370 | Johnathon Grant Winkler | Dentist | 3873 Robert C Byrd Dr, Beckley, WV 25801-2964 | 2008-04-28 |
| 1568648905 | Jamie Michele Day | Dentist | 106 Cambridge Pl, Bridgeport, WV 26330-2812 | 2008-01-16 |
| 1083787097 | Lori L Gochenour | Dentist | 113a Tavern Road, Martinsburg, WV 25401 | 2006-11-16 |
| 1619049475 | Lora Beth Ford | Dentist | 112 Morris St, Charleston, WV 25301-2911 | 2006-11-15 |
| 1306918776 | James W Vargo | Dentist | 92 Brookshire Ln, Beckley, WV 25801-6765 | 2006-11-14 |
| 1215038419 | Christopher Lindsay Hugh | Dentist | 3566 Teays Valley Rd, Hurricane, WV 25526-9090 | 2006-09-26 |
| 1033211081 | Larry Keith Hildebrand | Dentist | 1242 Washington Ave, Huntington, WV 25704 | 2006-09-01 |
| Find all providers with the same taxonomy | ||||
| City | MORGANTOWN |
| Zip Code | 26506 |
Please comment or provide details below to improve the information on CHARLES RUSSELL JACKSON.
| 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.