ANDREA DENISE JACKSON (NPI# 1578707204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578707204 |
| Entity Type | Individual |
| Full Name | ANDREA DENISE JACKSON |
| Other Name | DR. ANDREA D JACKSON |
| Credential | DDS, MS |
| Practice Address |
6912 Wade Ave Clinton MD 20735-2743 |
| Practice Telephone | 3018683317 |
| Mailing Telephone | 3018683317 |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-04-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0700X |
Dentist Specialization: Prosthodontics |
08111 | MD | Dental Providers |
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
DN4077 | DC | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568948479 | Andrea M Jackson | Behavioral Analyst | 2091 Business Center Dr Ste 150, Irvine, CA 92612-1167 | 2018-07-13 |
| 1912411133 | Andrea Jackson | Licensed Practical Nurse | 52 Hillside Ave, Freeport, NY 11520-1726 | 2017-11-27 |
| 1437670114 | Andrea Jackson | Nurse Practitioner | 406 W S Jordan Pkwy, South Jordan, UT 84095-3965 | 2017-07-03 |
| 1679003099 | Andrea Jackson | Social Worker | 306 Popula Blvd, Wappingers Falls, NY 12590-5712 | 2017-06-18 |
| 1578927638 | Andrea Jackson | Licensed Practical Nurse | 1617 Woodbine Ave Se, Warren, OH 44484-4964 | 2016-04-05 |
| 1649606617 | Andrea Jeanine Jackson | Social Worker | 2036 Wood St, Muskegon, MI 49444-1153 | 2013-09-22 |
| 1225371651 | Andrea Latrell Jackson | Social Worker | 10610 N 30th St, Apt. 46h, Tampa, FL 33612-6458 | 2013-04-04 |
| 1124383765 | Andrea Luthelle Jackson | Counselor | 1501 Nw 34th St, Oklahoma City, OK 73118-3203 | 2012-07-10 |
| 1457622656 | Andrea Jasmine Jackson | Behavioral Analyst | 7715 Nw 48 St, Suite B360, Miami, FL 33166 | 2012-01-19 |
| 1306140876 | Andrea Bessie Jackson | Case Manager/Care Coordinator | 6030 S May Ave Apt 451, Oklahoma City, OK 73159-1410 | 2010-12-27 |
| Street Address |
6912 WADE AVE |
| City | CLINTON |
| State | MD |
| Zip Code | 20735-2743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760940456 | Elise Olson | Occupational Therapist | 9135 Piscataway Rd, Suite 305, Clinton, MD 20735 | 2019-03-12 |
| 1437651742 | Total You Integrative Healthcare Inc | Clinic/Center | 9135 Piscataway Rd Ste 410, Clinton, MD 20735 | 2018-03-02 |
| 1386193233 | Benedicta C Osamor | Home Health Aide | 6808 Purple Lilac Ln, Clinton, MD 20735 | 2016-10-03 |
| 1669926309 | Frankline Ngozi Obi I | Home Health Aide | 8111 Highland Meadows Dr, Clinton, MD 20735 | 2016-08-11 |
| 1770952459 | Adventures One, Inc. | Clinic/Center | 7121 Old Alexandria Ferry Rd., Clinton, MD 20735 | 2015-09-23 |
| 1730574831 | Lindsey Degeorge | Emergency Medicine | 7503 Surratts Rd Dept Of, Clinton, MD 20735 | 2015-04-06 |
| 1316341860 | Margaret Laurence-whitlock | Speech-Language Pathologist | 5807 Terence Dr., Laurence Learning Center, Clinton, MD 20735 | 2014-10-13 |
| 1699103622 | Dcps | Social Worker | 5504 Trout Run Rd, Clinton, MD 20735 | 2013-10-30 |
| 1902232614 | Rafael Antonio Acosta | Dentist | 7905 Malcolm Rd Ste 300, Clinton, MD 20735 | 2013-09-25 |
| 1407135874 | Richelle Wilson Harvey | Occupational Therapist | 8202 Shackelford Way, Clinton, MD 20735 | 2011-08-16 |
| Find all providers in zip 20735 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417473273 | Andrey Doroshenko | Dentist | 1722 Underwood Road, Sykesville, MD 21784 | 2017-08-14 |
| 1275902298 | Yeremi A Canizales Dds P A | Dentist | 572 Ritchie Hwy Ste F, Severna Park, MD 21146-2966 | 2015-09-21 |
| 1770911273 | Fotini Chrisopoulos | Dentist | 11 N Eutaw St Apt 405, Baltimore, MD 21201-1794 | 2013-10-18 |
| 1548514730 | Churchton Dental Care | Dentist | 5570 Shady Side Rd, Unit A, Churchton, MD 20733-9639 | 2012-11-09 |
| 1124396551 | Guadalupe Garcia Fay | Dentist | 650 W Baltimore St # 4220, Baltimore, MD 21201-1510 | 2011-12-13 |
| 1598033136 | Mark Edward Brennan | Dentist | 882 Backbone Ct, Westminster, MD 21157-7745 | 2011-12-11 |
| 1366738536 | William E. Chmar | Dentist | 5952 Hubbard Dr, Rockville, MD 20852-4824 | 2011-06-25 |
| 1073812913 | Family Cosmetic & Implant Dentistry | Dentist | 3222 Powder Mill Rd, Adelphi, MD 20783-1037 | 2011-03-17 |
| 1831499433 | Stuart L. Graves Dental Associates, P.C. | Dentist | 11200 Rockville Pike Ste 115, Rockville, MD 20852-7114 | 2010-10-28 |
| 1679719165 | John Tran | Dentist | 9422 Curran Rd, Silver Spring, MD 20901-2804 | 2009-01-05 |
| 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.