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 Field Definition 1
1 NPI 1922318195 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name ALFRED M. JACKSON DDS,MS PLLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name JACKSON ORTHODONTICS Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 13527 STEELECROFT PKWY The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE C The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name CHARLOTTE The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name NC The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 28278 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 3522568164 The telephone number associated with the location address of the provider being identified.
14 Provider Enumeration Date 10/20/2010 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 10/20/2010 The date that a record was last updated or changed.
16 Authorized Official Last Name JACKSON The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name ALFRED The first name of the authorized official.
18 Authorized Official Middle Name MANWUEL The middle name of the authorized official.
19 Authorized Official Title or Position MANAGER/ORTHODONTIST The title or position of the authorized official.
20 Authorized Official Telephone Number 3522568164 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 1223X0400X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Provider License Number 1 8527 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
23 Provider License Number State Code 1 NC The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
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: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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