DR. KEITH DANIEL JACKSON DMD - NPI 1871935569 - Dentist in Charlottesville, VA

Q: What is the provider's specialty?

The provider's specialty is Dentist with taxonomy code 1223S0112X and a focus in Oral and Maxillofacial Surgery.

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About Dr. Keith Daniel Jackson Dmd NPPES

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

DR. KEITH DANIEL JACKSON DMD (NPI 1871935569) is an individual oral and maxillofacial surgery provider in Charlottesville, Virginia, licensed in Virginia (0401415969) and active in the NPI registry since July 2013. He has opted out of Medicare through April 19, 2027 and maintains a secondary practice location in Culpeper.

NPPES Registry Identity

NPI1871935569

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameDR. KEITH DANIEL JACKSONCredential: DMD

Location Address244 HYDRAULIC RIDGE RDCharlottesville, VA 22901-8124

Mailing Address244 Hydraulic Ridge RdCharlottesville, VA 22901-8124 · (434) 973-3348 · Fax (434) 977-5790

Phone(434) 973-3348

Fax(434) 977-5790

Sole ProprietorNo

Enumeration DateJuly 23, 2013

Last NPPES UpdateMarch 26, 20242 updates tracked since enumeration

NPPES CertifiedMay 18, 2021

✔ NPI 1871935569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in VA · 0401415969

Definition

An oral and maxillofacial surgery dentist specialized in 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.

244 HYDRAULIC RIDGE RD, Charlottesville, VA 22901

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Secondary Practice Location 1

Location 11400 Sunset LnCulpeper, VA 22701-3300 · Phone (540) 825-3069 · Fax (540) 825-7429

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

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Opted out of Medicare

Dr. Keith Daniel Jackson Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 19, 2021 through April 19, 2027.

Opt-Out Effective DateApril 19, 2021

Opt-Out In Effect ThroughApril 19, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 9

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

DR. EDWARD SULLIVAN AMRHEIN DDS

Dentist (Oral and Maxillofacial Surgery)