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Deactivated NPI 1043324122 Deactivated / Inactive NPI Male Practitioner

Dr. Jack Houston Self , DDS

Dentist • San Angelo, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jack Self has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 18, 2006
NPI Deactivation Date February 24, 2020
Total Practice Duration ~14 Years of Practice (2006 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Jack Self, DDS was a registered Dentist practicing in San Angelo, TX. Throughout an active medical career spanning 14 years, Dr. Self provided care at the practice location at 113 A & M ST until profile deactivation on 2020-02-24.

Practice Location & Contact Primary Location

Practice Address

113 A & M St

San Angelo, TX 769013661

Telephone 3259490595
Fax 3259421392

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in San Angelo, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.7 Yrs
Regional Practice Density
24 Specialists

Practicing in San Angelo, TX (6851 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License TX 7787

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated February 24, 2020

Record deactivated on February 24, 2020

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 113 A & M ST, SAN ANGELO, TX 769013661 (Tel: 3259490595)

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Updated Business Mailing Address July 08, 2007

Registered at 113 A & M ST, SAN ANGELO, TX 769013661 (Tel: 3259490595)

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Provider Name / Credentials Updated July 08, 2007

Recorded as JACK SELF, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #7787 in TX)

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Initial NPI Registration & Enumeration August 18, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1043324122
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 18, 2006
Last Update: July 08, 2007
Deactivation Date: February 24, 2020

Mailing Address

113 A & M St

San Angelo, TX 769013661

Phone: 3259490595

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.