LATRESA JACKSON DMD
NPI 1720485121
Dentist - General Practice in Hermitage, TN

Q: What is Latresa Jackson's NPI number?

The NPI number for Latresa Jackson is 1720485121. It was assigned to this individual provider in the NPPES registry on December 1, 2014.

Q: What is Latresa Jackson's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Latresa Jackson was last updated on November 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.

Active since December 01, 2014PECOS Enrolled

3901 CENTRAL PIKE STE 500, HERMITAGE, TN 37076(159) 337-3006 Get Directions Write a Review

NPPES record last updated: November 1, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 15, 2025, Jan 28, 2017 (2 updates tracked since 2017).

On this page

About Latresa Jackson Dmd NPPES

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

LATRESA JACKSON DMD (NPI 1720485121) is an individual general practice provider in Hermitage, Tennessee, licensed in Tennessee (9957) and active in the NPI registry since December 2014. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1720485121

Entity TypeIndividualFemale

Primary Taxonomy1223G0001X

Provider Legal NameLATRESA JACKSONCredential: DMD

Location Address3901 CENTRAL PIKE STE 500Hermitage, TN 37076-3431

Mailing Address3901 Central Pike Ste 500Hermitage, TN 37076-3431 · (615) 933-7300

Phone(159) 337-3006

Sole ProprietorNo

Enumeration DateDecember 1, 2014

Last NPPES UpdateNovember 1, 20252 updates tracked since enumeration

NPPES CertifiedNovember 1, 2025

✔ NPI 1720485121 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 · 9957✔ Licensed in KY · 10893

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.

3901 CENTRAL PIKE STE 500, Hermitage, TN 37076

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Latresa Jackson Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Latresa Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Kdnashvilledc

Same address

General Practice

3901 CENTRAL PIKE STE 500
Hermitage, TN 37076

Reassigned Medicare billing, Tennessee enrollment
3 clinicians in this Medicare group

NPI 1629767793 (615) 933-7300

Matthew Walker Comprehensive Health Center, Inc

11 mi

Federally Qualified Health Center (FQHC)

1035 14TH AVE N
Nashville, TN 37208

Reassigned Medicare billing, Tennessee enrollment
27 clinicians in this Medicare group

NPI 1356405278 (615) 327-9400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37076 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

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

MEERA M GANDHI PA-C

Physician Assistant (Medical)