# JUPITER 4GD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Adkison Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710679071
- **Authorized official:** DR. MICHAEL JAYSON TABOR DDS (OWNER)
- **Authorized official phone:** (615) 453-8900

## Contact information

- **Practice address:** 110 WINWOOD DR, LEBANON, TN 37087-3134
- **Practice address phone:** (615) 453-8900
- **Mailing address:** 110 WINWOOD DR, LEBANON, TN 37087-3134
- **Mailing address phone:** (615) 453-8900

## Taxonomy

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

## Other

- **Enumeration date:** 05/24/2023
- **Last updated:** 07/31/2023