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DR. JACKSON PETTY DDS
NPI 1417565193
Dentist - General Practice in Tullahoma, TN

Active since July 17, 2020
2118 N JACKSON ST, TULLAHOMA, TN 37388(931) 454-9499(931) 454-9499 Get Directions Write a Review

NPPES record last updated: January 21, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 12, 2025, Oct 3, 2024, Sep 23, 2024 and 2 more (5 updates tracked since 2020).

About Dr. Jackson Petty Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACKSON PETTY DDS (NPI 1417565193) is an individual general practice provider in Tullahoma, Tennessee, licensed in Tennessee (11423) and active in the NPI registry since July 2020.

NPPES Registry Identity

NPI1417565193
Entity TypeIndividual
Primary Taxonomy1223G0001X
Provider Legal NameDR. JACKSON PETTYCredential: DDS
Location Address2118 N JACKSON STTullahoma, TN 37388-2208
Mailing Address2118 N Jackson StTullahoma, TN 37388-2208 · (931) 454-9499 · Fax (931) 454-9499
Phone(931) 454-9499
Fax(931) 454-9499
Sole ProprietorNo
Enumeration DateJuly 17, 2020
Last NPPES UpdateJanuary 21, 20255 updates tracked since enumeration
NPPES CertifiedJanuary 21, 2025
✔ NPI 1417565193 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Licenses✔ Licensed in TN · 11423✔ Licensed in CO · 204657
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2118 N JACKSON ST, Tullahoma, TN 37388
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and more.Insurance ›

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PETTY DENTAL, PLLC
Clinic/Center (Dental)
2118 N JACKSON ST
TULLAHOMA, TN 37388
Coffee County (931) 454-9499
DR. JOHN E PETTY DMD
Dentist (General Practice)
2118 N JACKSON ST
TULLAHOMA, TN 37388
Coffee County (931) 454-9499

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Petty's NPI number?

The NPI number for Jackson Petty is 1417565193. It was assigned to this individual provider in the NPPES registry on July 17, 2020.

Where is Jackson Petty located?

Jackson Petty practices at 2118 N Jackson St, Tullahoma, TN 37388. The listed phone number is (931) 454-9499.

What is Jackson Petty's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Jackson Petty accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Humana and Renaissance Dental and 1 other insurer list Jackson Petty as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jackson Petty was last updated on January 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.