# ELITE DENTAL CARE JACKSON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite Dental Care Jackson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356076152
- **Authorized official:** TOM LANNOM (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (731) 855-1053

## Contact information

- **Practice address:** 47 N STAR DR, JACKSON, TN 38305-6647
- **Practice address phone:** (731) 664-9556
- **Mailing address:** 2066 US HIGHWAY 45 BYP S, TRENTON, TN 38382-3507
- **Mailing address phone:** (731) 855-1053

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/18/2022
- **Last updated:** 07/18/2022