Individual
LATRESA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3901 CENTRAL PIKE STE 500, HERMITAGE, TN 37076-3431
(159) 337-3006
Mailing address
3901 CENTRAL PIKE STE 500, HERMITAGE, TN 37076-3431
(615) 933-7300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10893
KY
1223G0001X
General Practice Dentistry
Primary
9957
TN
Other
Enumeration date
12/01/2014
Last updated
11/01/2025
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