Jerry Ray Driver, D.D.S.
Individual provider Active NPI General Practice Dentistry · Gainesboro, TN
NPI 1508081233 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508081233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS0000004017 (TN)
- Practice address
- 103 East Gore Ave.
Gainesboro, TN 38562-0595 - Phone
- (931) 268-9323
- NPI assigned
- Apr 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS0000004017 | TN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS0000004017 | TN | Yes |
Addresses
Primary practice location
103 East Gore Ave.
Gainesboro, TN 38562-0595
Mailing address
PO Box 595
Gainesboro, TN 38562-0595
Phone (931) 268-9323
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0016452 | Other | TN | TNCARE |
Other providers in Gainesboro, TN
- Michael Alcorn
- Anderson & Haile Drug Store
- Patricia L Conlan
- Timothy Crabtree
- Douglas Dycus
- Douglas C Dycus
- Jessica Foster
- Renee Franklin
- Gainesboro RX Corp
- Gainesboro Ultimate Med Service Corporation
All providers in Gainesboro, TN · General Practice Dentistry in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.