ALFRED M. JACKSON DDS,MS PLLC (JACKSON ORTHODONTICS) - NPI NUMBER 1922318195

Summary

Provider Name: ALFRED M. JACKSON DDS,MS PLLC (JACKSON ORTHODONTICS)

NPI Number: 1922318195

Clasification: Dentist (1223X0400X)

Specialization: Orthodontics and Dentofacial Orthopedics

Address:
13527 STEELECROFT PKWY
SUITE C
CHARLOTTE, NC
ZIP 28278

Phone Number: (352) 256-8164



Detailed Information

ALFRED M. JACKSON DDS,MS PLLC is an orthodontics and dentofacial orthopedics dentist in Charlotte, NC. The provider is that area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. The assigned NPI number for this provider is 1922318195 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Jackson Orthodontics.

The provider's business address is:

13527 STEELECROFT PKWY
SUITE C
CHARLOTTE, NC
ZIP 28278
Phone: (352) 256-8164

The provider's authorized official is Alfred Manwuel Jackson .
The authorized official title is Manager/orthodontist and has the following contact phone number (352) 256-8164.

The enumeration date for this NPI number is 10/20/2010 and was last updated on 10/20/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics 8527 NC Yes

NPI Record

No. Field Name Field Value
1 NPI 1922318195
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name ALFRED M. JACKSON DDS,MS PLLC
5 Provider Other Organization Name JACKSON ORTHODONTICS
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 13527 STEELECROFT PKWY
8 Provider Second Line Business Practice Location Address SUITE C
9 Provider Business Practice Location Address City Name CHARLOTTE
10 Provider Business Practice Location Address State Name NC
11 Provider Business Practice Location Address Postal Code 28278
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 3522568164
14 Provider Enumeration Date 10/20/2010
15 Last Update Date 10/20/2010
16 Authorized Official Last Name JACKSON
17 Authorized Official First Name ALFRED
18 Authorized Official Middle Name MANWUEL
19 Authorized Official Title or Position MANAGER/ORTHODONTIST
20 Authorized Official Telephone Number 3522568164
21 Healthcare Provider Taxonomy Code 1 1223X0400X
22 Provider License Number 1 8527
23 Provider License Number State Code 1 NC
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Is Organization Subpart N
26 Authorized Official Name Prefix Text DR.
27 Authorized Official Credential Text DDS,MS
28 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.