IndividualActive
Jackson Petty, DDS
NPI 1417565193 · General Practice Dentistry · Tullahoma, TN
Jackson Petty, DDS is a General Practice Dentistry provider in Tullahoma, TN (NPI 1417565193).
Provider details
- NPI number
- 1417565193
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DDS
- Sole proprietor
- No
- License
- 204657 (CO)
Specialties & taxonomies
Dental Providers
Dental Providers
Profile Score
Established profile(64/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2118 N Jackson St
Tullahoma, TN 37388-2208
Phone: (931) 454-9499
Fax: (931) 454-9499
Street-level locationGet directions
Mailing address
2118 N Jackson St
Tullahoma, TN 37388-2208
Registry dates
- Enumerated
- 2020-07-17
- Last updated
- 2025-01-21
- Certified
- 2025-01-21
Frequently asked questions
- What is Jackson Petty's NPI number?
- Jackson Petty's National Provider Identifier (NPI) is 1417565193, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Jackson Petty's specialty?
- Jackson Petty is listed in the NPPES registry with a primary specialty of General Practice Dentistry (Dental Providers).
- Where is Jackson Petty located?
- Jackson Petty's practice location on file with NPPES is 2118 N Jackson St, Tullahoma, TN 37388-2208.
- What is Jackson Petty's phone number?
- The practice phone number listed in the NPPES registry for Jackson Petty is (931) 454-9499.
- Is Jackson Petty's NPI active?
- Yes — Jackson Petty's NPI (1417565193) is active in the NPPES registry as of the last update on 2025-01-21.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.