Jupiter 4GD, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

JUPITER 4GD, LLC

Doing business as

Adkison Family Dental

Practice address

110 Winwood Dr
Lebanon, TN 37087-3134

Phone

(615) 453-8900

NPI assigned

May 24, 2023

Last updated

Jul 31, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Jayson Tabor, DDSNPI 1174749766

Title

Owner

Phone

(615) 453-8900

Specialties & licenses 1

Addresses

Other names 1

• Adkison Family Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Jayson Tabor, D.D.S.

  • General Practice Dentistry
  • Hendersonville, TN
  • NPI 1174749766
  NPD Authorized official

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1710679071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WINWOOD DR",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873134",
            "telephone_number": "615-453-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 WINWOOD DR",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370873134",
            "telephone_number": "615-453-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUPITER 4GD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "TABOR",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAYSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-453-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adkison Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stacey Lynn Jones, PHARMD
• Charles Andrew Jordan, MD
• Eboni Jordan, APRN, FNP-C
• James B Jordan, RCEP
• Teresa D. Jordan, RN
• Michael J Kanak, B.S.,HIS
• Shiyar Kapan, RPH
• Modupe Olusegun Kehinde, M.D.
• Kimberly Keller, FNP
• Barbra Cierra Kelley, MMFT

• Dental Clinic/Center in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.