# R. COREY JACKSON DDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043306467
- **Authorized official:** DR. RONALD COREY JACKSON D.D.S. (MANAGING MEMBER)
- **Authorized official phone:** (615) 754-5840

## Contact information

- **Practice address:** 2365 N MOUNT JULIET RD, MT JULIET, TN 37122-3038
- **Practice address phone:** (615) 754-5840
- **Mailing address:** 308 GRANDVIEW DR, OLD HICKORY, TN 37138-1645
- **Mailing address phone:** (615) 758-9670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8279 | TN | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/22/2020