NPIMap

Organization Active NPI

Elite Dental Care Jackson

  • Dental Clinic/Center
  • Jackson, TN
National Provider Identifier
1356076152
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
ELITE DENTAL CARE JACKSON
Practice address
47 N Star Dr
Jackson, TN 38305-6647
Phone
(731) 664-9556
NPI assigned
Jul 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Tom Lannom
Title
Chief Operating Officer
Phone
(731) 855-1053

Specialties & licenses 1

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

Addresses

Primary practice location

47 N Star Dr
Jackson, TN 38305-6647

Mailing address

2066 US Highway 45 Byp S
Trenton, TN 38382-3507
Phone (731) 855-1053

Other names 1

  • Elite Dental Care Jackson Doing business as

Practitioners 9

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

National Provider Directory

National Provider Directory

Locations

47 N Star Dr
Jackson, TN 38305
Phone (731) 664-0213

NPI Registry JSON

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

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1356076152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2066 US HIGHWAY 45 BYP S",
            "city": "TRENTON",
            "state": "TN",
            "postal_code": "383823507",
            "telephone_number": "731-855-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 N STAR DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383056647",
            "telephone_number": "731-664-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL CARE JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "LANNOM",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "731-855-1053"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Care Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.