Individual
DR. JACKSON PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Credential
DDS
Contact information
Practice address
2118 N JACKSON ST, TULLAHOMA, TN 37388-2208
(931) 454-9499
(931) 454-9499
Mailing address
2118 N JACKSON ST, TULLAHOMA, TN 37388-2208
(931) 454-9499
(931) 454-9499
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11423
TN
1223G0001X
General Practice Dentistry
204657
CO
Other
Enumeration date
07/17/2020
Last updated
01/21/2025
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