KYLE R. JACKSON, DDS, LLC (NPI# 1710546437) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710546437 |
| Entity Type | Organization |
| Organization Name | KYLE R. JACKSON, DDS, LLC |
| Practice Address |
4090 Indian Ripple Rd Unit 102 Beavercreek OH 45440-3253 |
| Mailing Address |
273 Regency Ridge Dr Centerville OH 45459-4221 |
| Practice Telephone | 9375867729 |
| Practice Fax Number | 9374909904 |
| Mailing Telephone | 9375867729 |
| Mailing Fax Number | 9376604450 |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2019-06-06 |
| Authorized Official Name | KYLE R. JACKSON (OWNER) |
| Authorized Official Telephone | 9375867729 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Keep Smiling Kids | Doing Business As Name - Organization |
| Street Address |
4090 INDIAN RIPPLE RD UNIT 102 |
| City | BEAVERCREEK |
| State | OH |
| Zip Code | 45440-3253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427657568 | Jason Michael Knippen | Pharmacist | 5400 Cornerstone, Centerville, OH 45440 | 2020-10-20 |
| 1184222564 | Kimberly Downs | Pharmacist | 5400 North Cornerstone Blvd, Centerville, OH 45440 | 2020-10-16 |
| 1659902153 | Caryn Hoffman | Pharmacist | 5400 Cornerstone Blvd, Centerville, OH 45440 | 2020-02-03 |
| 1023673100 | Katren Elizabeth Clark | Psychologist | 70 Birch Alley, Suite 240, Dayton, OH 45440 | 2019-05-05 |
| 1649784737 | Amy Lynn Winstead | Dietitian, Registered | 5721 Bigger Road, Kettering, OH 45440 | 2017-11-28 |
| 1104245455 | Aprscp, Inc. | Hearing Instrument Specialist | 3341 East Stroop Road, Kettering, OH 45440 | 2014-04-15 |
| 1457601858 | Victoria L Saylor | Pharmacy Technician | 4480 Indianripple Rd, Dayton, OH 45440 | 2012-09-12 |
| 1528368644 | Sara Jankowski | Art Therapist | 5178 Scarsdale Dr., Kettering, OH 45440 | 2010-10-22 |
| 1356651012 | Senior Options Group | Home Health | 4025 Marshall Road, Kettering, OH 45440 | 2010-10-15 |
| 1417106345 | Sheenu Goel | Dentist | 4235 Indian Ripple Rd., Suite 200a, Dayton, OH 45440 | 2008-09-16 |
| Find all providers in zip 45440 | ||||
| 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 |
|---|---|---|---|---|
| 1972600989 | Gordon W Womack | Dentist | 3300 Kemp Rd, Beavercreek, OH 45431-4200 | 2006-09-20 |
| 1922585694 | Gordon W. Womack Dds Inc | Dentist | 3300 Kemp Rd, Beavercreek, OH 45431 | 2018-07-25 |
| 1871016097 | Indervir Mann | Dentist | 3300 Kemp Rd, Beavercreek, OH 45431-4200 | 2017-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255931911 | Rachel I Rosen, Dds LLC | Dentist | 9964 Vail Dr Ste 1, Twinsburg, OH 44087-2972 | 2020-10-30 |
| 1861014334 | Page Pediatric Dentistry | Dentist | 5699 Innovation Dr, Dublin, OH 43016-3312 | 2020-05-07 |
| 1629602412 | Tuka N/a Sada | Dentist | 9601 Chester Ave Rm 284-h, Cleveland, OH 44106-1666 | 2020-03-02 |
| 1992336093 | Al Saad Dental LLC | Dentist | 7250 Center St Ste C, Mentor, OH 44060-4920 | 2020-01-28 |
| 1912547811 | Cincy Pediatric Dentistry, LLC | Dentist | 1131 Cryer Ave, Cincinnati, OH 45208 | 2020-01-09 |
| 1790338168 | Corbin Salthouse | Dentist | 13390 Cedar Rd, Cleveland Heights, OH 44118-2955 | 2019-07-24 |
| 1588223929 | Amber Sun | Dentist | 11100 Euclid Ave # Rb&c1200, Cleveland, OH 44106-1716 | 2019-06-10 |
| 1932764107 | Cuadra Pediatric Dentistry, LLC | Dentist | Cuadra Pediatric Dentistry, LLC, 486 Wentz Street, Tiffin, OH 44883 | 2019-05-03 |
| 1265901136 | Ohio Dental Team LLC | Dentist | 7690 First Place, Bldg D, Suite E, Oakwood, OH 44146 | 2018-11-20 |
| 1912408493 | Elizabeth Mueller, Dds & Associates | Dentist | 6396 Thornberry Ct Ste 720, Mason, OH 45040-7815 | 2018-02-21 |
| Find all providers with the same taxonomy | ||||
| City | BEAVERCREEK |
| Zip Code | 45440 |
Please comment or provide details below to improve the information on KYLE R. JACKSON, DDS, LLC.
| 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.