Latresa Jackson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9957 Issued in TN

Practice address

3901 Central Pike Ste 500
Hermitage, TN 37076-3431

Phone

(159) 337-3006

NPI assigned

Dec 1, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kdnashvilledc

  • General Practice Dentistry
  • Hermitage, TN
  • NPI 1629767793
  Medicare reassignment NPD
• Matthew Walker Comprehensive Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Nashville, TN
  • NPI 1356405278
  Medicare reassignment NPD

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

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761955200000",
    "number": "1720485121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 CENTRAL PIKE STE 500",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370763431",
            "telephone_number": "615-933-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CENTRAL PIKE STE 500",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370763431",
            "telephone_number": "159-337-3006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LATRESA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-01",
        "last_updated": "2025-11-01",
        "certification_date": "2025-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "9957",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10893",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intellicare
• John W Interlandi, MD
• Internal Medicine of Summit, P.C.
• Jessica Ivy, MS, RD, LDN
• Lisa M Jabusch, M.D.
• Danielle Elizabeth Jacobs, PHYSICAL THERAPIST
• Marjorie James
• Megan K James, LMFT
• Martha Jameson
• Kayla Janovsky

• General Practice Dentistry in Hermitage, TN
• Providers in Hermitage, 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 Nov 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.