DR. LARRY TYLER JACKSON (NPI# 1396186276) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396186276 |
| Entity Type | Individual |
| Full Name | DR. LARRY TYLER JACKSON |
| Credential | D.D.S. |
| Practice Address |
14100 N 83rd Ave Ste 280 Peoria AZ 85381-5658 |
| Practice Telephone | 6239359873 |
| Mailing Telephone | 6239359873 |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2017-04-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
D009113 | AZ | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568855724 | Larry Jackson Jr. | Specialist/Technologist | 826 Warfield Pl, Lexington, KY 40505-3612 | 2015-03-12 |
| 1093878191 | Larry Randolph Jackson | Registered Nurse | 615 Rapids Rd, Columbia, SC 29212-3024 | 2006-12-19 |
| 1710068499 | Larry M. Jackson | Nutritionist | 9357 S Kingston Ave, Chicago, IL 60617-4042 | 2006-10-18 |
| 1093169062 | Larry Jackson Jr. | Counselor | 1420 Central Ave, Dubuque, IA 52001-4842 | 2016-04-15 |
| 1679971667 | Larry Jackson | Specialist | 1501 5th Ave N, St Petersburg, FL 33705-2008 | 2014-12-08 |
| 1578880548 | Larry Arthur Jackson | Family Medicine | 1445 Gateway Blvd, Cottage Grove, OR 97424-1224 | 2010-04-29 |
| 1023285582 | Larry Ronald Jackson II | Internal Medicine | 2301 Erwin Rd, Durham, NC 27710-0001 | 2008-05-14 |
| 1912928441 | Larry D Jackson | Personal Emergency Response Attendant | 500 Gypsy Ln, Youngstown, OH 44504-1315 | 2006-07-21 |
| 1275574295 | Larry K Jackson | Internal Medicine | 2660 10th Ave S, Suite 528, Birmingham, AL 35205-1605 | 2006-06-09 |
| 1720049349 | Larry Jackson | Family Medicine | 6565 W Main St, Kalamazoo, MI 49009-6114 | 2006-03-31 |
| Street Address |
14100 N 83RD AVE STE 280 |
| City | PEORIA |
| State | AZ |
| Zip Code | 85381-5658 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932712122 | Vicki L Grenier | Registered Nurse | 7558 W. Thunderbird Rd. Ste 1-507, Peoria, AZ 85381 | 2020-08-26 |
| 1568934107 | Earthwalk Wellness Group, LLC | Social Worker | 14050 North 83rd Avenue, Suite 290, Peoria, AZ 85381 | 2018-12-20 |
| 1316412059 | John & Biljana Feeley Dba J & B Assisted Living IIi Inc | Community Based Residential Treatment Facility, Mental Illness | 7331 W Sweetwater Avenue, Peoria, AZ 85381 | 2018-10-09 |
| 1467958611 | Arizona Community Pharmacy | Pharmacy | 14100 N 83rd Ave Ste 160, Peoria, AZ 85381 | 2018-04-04 |
| 1083112106 | Marissa Lynn Desjardins | Physical Therapist | 8240 W. Cactus Rd. Oakeson Physical Therapy, Peoria, AZ 85381 | 2018-01-23 |
| 1235651399 | Power Back Batteries LLC | Durable Medical Equipment & Medical Supplies | 9054 West Lisbon Ave, Peoria, AZ 85381 | 2017-07-11 |
| 1457897027 | Sonoran Sky Community Services | Community Based Residential Treatment Facility, Mental Illness | 7524 W. Alexandria Way, Peoria, AZ 85381 | 2017-01-06 |
| 1386023448 | Scott Boone | Registered Nurse | 7715 W Watson Ln, Peoria, AZ 85381 | 2015-05-22 |
| 1881084838 | Pinnacle Women's Center LLC | Obstetrics & Gynecology | 15396 N 83rd Ave Ste F100, Peoria, AZ 85381 | 2015-01-29 |
| 1245637081 | Kathi Locke | Counselor | 13460 N. 94th Drive, Suite J2, Peoria, AZ 85381 | 2014-11-21 |
| Find all providers in zip 85381 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568957199 | Maureen Malingkas | Dentist | 8248 W Deer Valley Rd, Peoria, AZ 85382-2198 | 2018-06-26 |
| 1942541206 | Robert Dean Matthews | Dentist | 25225 N Lake Pleasant Pkwy Ste 1235, Peoria, AZ 85383-1390 | 2013-03-12 |
| 1609141464 | Kids First Dental Group | Dentist | 7314 N Willow Lake Ct Ste D, Peoria, IL 61614-8289 | 2012-03-13 |
| 1649558578 | Morghan Elizabeth Teeters | Dentist | 7505 W. Deer Valley Rd, Suite 110, Peoria, AZ 85382 | 2011-07-26 |
| 1558656223 | Fatima P. Pimentel | Dentist | 7505 W Deer Valley Rd Ste 110, Peoria, AZ 85382-2107 | 2011-06-10 |
| 1952472276 | Christa Yvette Spates | Dentist | 1320 W Northmoor Rd, Peoria, IL 61614-3470 | 2006-11-10 |
| 1912095126 | Gregory Whelan | Dentist | 9840 W Yearling Rd, #1240, Peoria, AZ 85383-1377 | 2006-10-11 |
| 1629616826 | Morghan E. Teeters Dmd, Pllc | Dentist | 7505 W Deer Valley Rd Ste 110, Peoria, AZ 85382-2107 | 2019-12-18 |
| 1962923359 | Robert D Matthews, Dmd, Pllc | Dentist | 25225 N Lake Pleasant Pkwy Ste 1235, Peoria, AZ 85383-1390 | 2017-07-06 |
| 1336535152 | Kidz R Kool | Dentist | 7505 W Deer Valley Rd, Suite 110, Peoria, AZ 85382-2107 | 2015-04-08 |
| Find all providers in PEORIA | ||||
Please comment or provide details below to improve the information on DR. LARRY TYLER 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.