Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Theodore Michael Jackson, DMD

Individual provider General Practice Dentistry · NPI 1912981945

Dr. Theodore Michael Jackson, DMD is a General Practice Dentistry in Columbus, Ohio. Licensed in Illinois and Ohio. Registered with an NPI since 2005.

Licensed in
IL, OH
In the registry since
2005
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

305 W 12th Ave
Columbus, OH 43210-1267
Phone: (614) 247-6590
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 30.026788 (OH)
General Practice Dentistry Taxonomy 1223G0001X · Licence 19026503 (IL)

Record details

NPI number1912981945
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorNo
NPI enumeratedDecember 2, 2005
Last updated in NPPESFebruary 21, 2023
Certification dateFebruary 21, 2023
Mailing address1254 N High St Apt 307, Columbus, OH 43201-2438

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