Stacy Marie Jackson, DDS

Pediatric Dentistry · Boulder, CO

Individual Active NPI

NPI number 1043530991

Practice location

3400 Penrose Pl Ste 107
Boulder, CO 80301-1809
Phone
(303) 443-8250

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NPI record

NPI
1043530991
Entity type
Individual (Type 1)
Enumeration date
June 2, 2010
Last updated
April 26, 2023
Certified
April 26, 2023
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatric Dentistry Primary 1223P0221X DEN.00202791 CO
Dentist 122300000X 2010016174 MO

Mailing address

291 Maddox Lane
Erie, CO 80516
Phone
(785) 249-2973

Other practice locations (1)

  • 5150 W 80th Ave, Westminster, CO 80030-4449 · (303) 427-1951

About Dr. Jackson

Stacy Marie Jackson, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatric Dentistry (code 1223P0221X). The practice location is 3400 Penrose Pl Ste 107, Boulder, CO 80301-1809. The NPI number 1043530991 was assigned on June 2, 2010 and the record was last updated on April 26, 2023.

Dr. Jackson lists 2 licenses in the registry: #DEN.00202791 (CO) for Pediatric Dentistry; #2010016174 (MO) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Stacy Marie Jackson, DDS?

The NPI number is 1043530991.

What is the phone number of Dr. Jackson?

The phone number listed for the practice location is (303) 443-8250.

Where is Dr. Jackson located?

3400 Penrose Pl Ste 107, Boulder, CO 80301-1809.

What is the taxonomy code for Dr. Jackson?

The primary taxonomy code is 1223P0221X – Pediatric Dentistry; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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