Jesse Steven Pollom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11306 Issued in TN

Practice address

1605 Williams Rd
Hixson, TN 37343-4934

Phone

(423) 843-0418

NPI assigned

Jul 27, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Dental Group, PLLC

  • General Practice Dentistry
  • Hixson, TN
  • NPI 1487432811
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1013526946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 WILLIAMS RD",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 WILLIAMS RD",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434934",
            "telephone_number": "423-843-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLOM",
        "first_name": "JESSE",
        "middle_name": "STEVEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TN",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard W Pigg, MD
• Elizabeth A Pillow
• Pink Skies Wellness
• Christina Marie Pish, O.D.
• Courtney Pittman, OCCUPATION THERAPIST
• Brian Porbansky, PT, DPT
• Lakendra Porter, NP
• Jeffrey Charles Poteralski
• Donna Jeanne Prelog, CNM
• Premier Family Dental

• General Practice Dentistry in Hixson, TN
• Providers in Hixson, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.