DR. KEITH DANIEL JACKSON (NPI# 1871935569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871935569 |
| Entity Type | Individual |
| Full Name | DR. KEITH DANIEL JACKSON |
| Credential | DMD |
| Practice Address |
10868 Us Highway 15 501 Southern Pines NC 28387-5149 |
| Mailing Address |
4590 Woodmere Blvd Montgomery AL 36106-2918 |
| Practice Telephone | 9109923089 |
| Mailing Telephone | 7704016524 |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2020-11-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
12053 | NC | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
6483 | AL | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4590 Woodmere Blvd, Montgomery, AL 36106 | 7704016524 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407491673 | Keith Jackson | Home Health | 2934 Pelzer Ave, Montgomery, AL 36109-2147 | 2019-11-12 |
| 1720263031 | Keith Edward Jackson | Nurse Practitioner | 11114 Endicott Ln, Houston, TX 77035-3007 | 2008-01-04 |
| 1205866142 | Keith E Jackson | Nurse Anesthetist, Certified Registered | 100 Rice Mine Rd N, Tuscaloosa, AL 35406-2300 | 2006-07-04 |
| 1225016454 | Keith Jackson | Otolaryngology | 1360 Upper Hembree Rd Ste 201b, Roswell, GA 30076-1230 | 2006-01-06 |
| 1184278129 | Keith T. Jackson | Physical Therapist | 4000 Johnson Rd, Steubenville, OH 43952-2364 | 2019-07-29 |
| 1326527045 | Keith Allen Jackson | Physician Assistant | 3000 Q St Fl 4, Sacramento, CA 95816-7058 | 2018-08-13 |
| 1457837551 | Keith Jackson | Case Manager/Care Coordinator | 1430 Olive St Ste 400, Saint Louis, MO 63103-2303 | 2018-07-12 |
| 1952890030 | Keith Wesley Jackson | Pharmacist | 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 | 2018-05-04 |
| 1033557228 | Keith L Jackson | Rehabilitation Practitioner | 7381 Prairie Falcon Rd, Las Vegas, NV 89128-0811 | 2013-06-10 |
| 1033461280 | Keith Darnell Jackson | Social Worker | 7550 Constantinople Ave, Las Vegas, NV 89129-6505 | 2012-10-12 |
| Street Address |
10868 US HIGHWAY 15 501 |
| City | SOUTHERN PINES |
| State | NC |
| Zip Code | 28387-5149 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861972028 | Wright and Associates X Dds Pa | Dentist | 10677 Nc Hwy 15-501, Southern Pines, NC 28387 | 2018-08-17 |
| 1821507294 | Brooke Ashley Thomas | Physical Therapist | 275 Pinehurst Ave Suite B, Southern Pines, NC 28387 | 2017-09-28 |
| 1497208987 | Laura Permelia Jackson | Specialist/Technologist | 3300 Airport Road, Southern Pines, NC 28387 | 2016-08-01 |
| 1164860417 | Monarch | Community/Behavioral Health | 1662 Richards St, Southern Pines, NC 28387 | 2013-06-10 |
| 1619313202 | Nicole Jacobs | Psychiatry & Neurology | 195 West Illinois Avenue, Attn: April Smith, Southern Pines, NC 28387 | 2013-05-22 |
| 1932458395 | Heather N Dunning | Social Worker | 230 Murray Hill Rd, Southern Pines, NC 28387 | 2012-08-31 |
| 1487948451 | Hugh Perry Gayman Jr. | Physical Therapist | 103 Gossman Dr, Southern Pines, NC 28387 | 2011-06-07 |
| 1083919245 | John Adam Petty | Chiropractor | 1295 Old Us 1, Suite F, Southern Pines, NC 28387 | 2011-01-20 |
| 1962704775 | Specialty Pharmacy-southern Pines LLC | Pharmacy | 735 S. Bennett St., Southern Pines, NC 28387 | 2010-11-30 |
| 1922317080 | At Home Senior Services, Inc. | Home Health | 340 Commerce Avenue, Suite 14-a Yadkin Plaza, Southern Pines, NC 28387 | 2010-10-06 |
| Find all providers in zip 28387 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689224495 | Graham H. Wilson, Dds, Pa | Dentist | 7971 Market Street, Wilmington, NC 28411-9383 | 2019-09-13 |
| 1699263137 | John Breeze | Dentist | Duke University Medical Centre, Durham, NC 27710-0001 | 2018-04-30 |
| 1750823746 | Nazir Ahmad Dds V Pa | Dentist | 2500 Blue Ridge Rd Ste 201, Raleigh, NC 27607-7515 | 2016-11-08 |
| 1447600119 | Jason Michael Goldberg | Dentist | 8815 Christenbury Pkwy Ste 40, Concord, NC 28027-0261 | 2016-06-14 |
| 1760839757 | Nazir Ahmad Dds Iv, Pa | Dentist | 3150 Rogers Rd Ste 111, Wake Forest, NC 27587-4196 | 2016-05-19 |
| 1801262530 | Bradley Paul Storrs | Dentist | 6837 Normandy Rd Bldg B, Attn: Charles Bernatovitz, Fort Bragg, NC 28310-0001 | 2015-08-17 |
| 1003296831 | Jesse Eric Ricciuti | Dentist | 10042 Park Cedar Dr Ste B, Charlotte, NC 28210 | 2015-06-07 |
| 1518346105 | Christopher Abernathy | Dentist | 3111 Springbank Ln Ste A, Charlotte, NC 28226 | 2015-05-28 |
| 1255737078 | Platte Valley Oral & Maxillofacial Surgery LLC | Dentist | 416 Valley View Drive, Suite 800, Scottsbluff, NC 69361-1420 | 2014-11-05 |
| 1780080655 | Robert L Stutts IIi Dmd Paii | Dentist | 200 E Wendover Ave Ste B, Greensboro, NC 27401-1227 | 2014-11-05 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHERN PINES |
| Zip Code | 28387 |
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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.