NPIMap

Organization Active NPI

Petty Dental, PLLC

  • Dental Clinic/Center
  • Tullahoma, TN
National Provider Identifier
1215747100
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PETTY DENTAL, PLLC
Practice address
2118 N Jackson St
Tullahoma, TN 37388-2208
Phone
(931) 454-9499
Fax
(931) 454-9499
NPI assigned
Jan 13, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Dr. Jackson Petty, DDSNPI 1417565193
Title
Owner
Phone
(931) 454-9499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2118 N Jackson St
Tullahoma, TN 37388-2208

Mailing address

2118 N Jackson St
Tullahoma, TN 37388-2208
Phone (931) 454-9499

National Provider Directory

National Provider Directory

Locations

2118 N Jackson St
Tullahoma, TN 37388
Phone (931) 454-9499

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1215747100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882208",
            "telephone_number": "931-454-9499",
            "fax_number": "931-454-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882208",
            "telephone_number": "931-454-9499",
            "fax_number": "931-454-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-12",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-454-9499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.