Jackson Petty, DDS

General Practice Dentistry · Tullahoma, TN

Individual Active NPI

NPI number 1417565193

Practice location

2118 N Jackson St
Tullahoma, TN 37388-2208
Phone
(931) 454-9499
Fax
(931) 454-9499

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NPI record

NPI
1417565193
Entity type
Individual (Type 1)
Enumeration date
July 17, 2020
Last updated
January 21, 2025
Certified
January 21, 2025
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X 11423 TN
General Practice Dentistry 1223G0001X 204657 CO

About Dr. Petty

Jackson Petty, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 2118 N Jackson St, Tullahoma, TN 37388-2208. The NPI number 1417565193 was assigned on July 17, 2020 and the record was last updated on January 21, 2025.

Dr. Petty lists 2 licenses in the registry: #11423 (TN) for General Practice Dentistry; #204657 (CO) for General Practice Dentistry. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jackson Petty, DDS?

The NPI number is 1417565193.

What is the phone number of Dr. Petty?

The phone number listed for the practice location is (931) 454-9499.

Where is Dr. Petty located?

2118 N Jackson St, Tullahoma, TN 37388-2208.

What is the taxonomy code for Dr. Petty?

The primary taxonomy code is 1223G0001X – General Practice 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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