NPIMap

Organization Active NPI

Mt. Juliet Dental Group, PC

  • Dentist
  • Mt. Juliet, TN
National Provider Identifier
1720537491
Registry record updated Oct 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MT. JULIET DENTAL GROUP, PC
Practice address
4155 N Mt Juliet Rd
Mt. Juliet, TN 37122
Phone
(615) 241-8023
Fax
(615) 922-3768
NPI assigned
Sep 23, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2016

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

Authorized official

Name
Dr. Tanisha A Jackson, DDS
Title
Owner Dentist
Phone
(615) 241-8023

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4155 N Mt Juliet Rd
Mt. Juliet, TN 37122

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Mt. Juliet Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

4155 N Mount Juliet Rd
Mt Juliet, TN 37122
Phone (615) 241-8023

Practitioners & affiliated clinicians

Practitioners 6

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": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1720537491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 N MT JULIET RD",
            "city": "MT. JULIET",
            "state": "TN",
            "postal_code": "37122",
            "telephone_number": "615-241-8023",
            "fax_number": "615-922-3768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. JULIET DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-23",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TANISHA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "615-241-8023",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Juliet Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mt. Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; 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.