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DR. LARRY TYLER JACKSON D.D.S.
NPI 1396186276
Dentist - Pediatric Dentistry in Peoria, AZ

Active since July 08, 2013PECOS Enrolled
14100 N 83RD AVE, STE 280, PEORIA, AZ 85381(623) 935-9873 Get Directions Write a Review

NPPES record last updated: April 7, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Larry Tyler Jackson D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LARRY TYLER JACKSON D.D.S. (NPI 1396186276) is an individual pediatric dentistry provider in Peoria, Arizona, licensed in Arizona (D009113) and active in the NPI registry since July 2013. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1396186276
Entity TypeIndividualMale
Primary Taxonomy1223P0221X
Provider Legal NameDR. LARRY TYLER JACKSONCredential: D.D.S.
Location Address14100 N 83RD AVE, STE 280Peoria, AZ 85381-5658
Mailing Address14100 N 83rd Ave, Ste 280Peoria, AZ 85381-5658 · (623) 935-9873
Phone(623) 935-9873
Sole ProprietorNo
Enumeration DateJuly 8, 2013
Last NPPES UpdateApril 7, 2017
✔ NPI 1396186276 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in AZ · D009113
Definition
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.
14100 N 83RD AVE, Peoria, AZ 85381
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Anthem Blue Cross and Blue Shield, BEST Life and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Larry Tyler Jackson D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85381 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PARTNERS IN RECOVERY, LLC
Clinic/Center (Adult Mental Health)
14100 N 83RD AVE, SUITE 100, 150
PEORIA, AZ 85381
Maricopa County (623) 583-0232
JACQUELYN RENE BYBEE RNP
Nurse Practitioner (Psychiatric/Mental Health)
14100 N 83RD AVE
PEORIA, AZ 85381
Maricopa County (623) 583-0232
JUAN RAMON HERRERA APRN PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
14100 N 83RD AVE
PEORIA, AZ 85381
Maricopa County (623) 523-6600
DR. TARAN GOODBALLET PHARMD
Pharmacist (Psychiatric)
14100 N 83RD AVE
PEORIA, AZ 85381
Maricopa County (623) 230-3194

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Larry Jackson's NPI number?

The NPI number for Larry Jackson is 1396186276. It was assigned to this individual provider in the NPPES registry on July 8, 2013.

Where is Larry Jackson located?

Larry Jackson practices at 14100 N 83rd Ave Ste 280, Peoria, AZ 85381. The listed phone number is (623) 935-9873.

What is Larry Jackson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Is Larry Jackson enrolled in Medicare?

Yes. Larry Jackson is registered in the Medicare PECOS enrollment system.

What insurance does Larry Jackson accept?

Health plans from Ambetter from Arizona Complete Health, Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross Blue Shield of Arizona and Blue Cross and Blue Shield of Montana and 11 other insurers list Larry Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Larry Jackson was last updated on April 7, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.