Dr Larry Tyler Jackson, DDS - Medicare Dentist in Peoria, AZ

Dr Larry Tyler Jackson, DDS is a medicare enrolled "Dentist - Pediatric Dentistry" provider in Peoria, Arizona. His current practice location is 14100 N 83rd Ave, Ste 280, Peoria, Arizona. You can reach out to his office (for appointments etc.) via phone at (623) 935-9873.

Dr Larry Tyler Jackson is licensed to practice in Arizona (license number D009113) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1396186276.

Contact Information

Dr Larry Tyler Jackson, DDS
14100 N 83rd Ave, Ste 280,
Peoria, AZ 85381-5658
(623) 935-9873
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameDr Larry Tyler Jackson
GenderMale
SpecialityDentist - Pediatric Dentistry
Location14100 N 83rd Ave, Peoria, Arizona
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1396186276
  • Provider Enumeration Date: 07/08/2013
  • Last Update Date: 04/07/2017
  Medicare PECOS Information:
  • PECOS PAC ID: 3375810013
  • Enrollment ID: I20170530002134

Medical Identifiers

Medical identifiers for Dr Larry Tyler Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1396186276NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223P0221XDentist - Pediatric Dentistry D009113 (Arizona)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Larry Tyler Jackson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Larry Tyler Jackson, DDS
14100 N 83rd Ave, Ste 280,
Peoria, AZ 85381-5658

Ph: (623) 935-9873
Dr Larry Tyler Jackson, DDS
14100 N 83rd Ave, Ste 280,
Peoria, AZ 85381-5658

Ph: (623) 935-9873

Reviews and Comments


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