| Petty Dental, Pllc | |
|
2118 N Jackson St Tullahoma TN 37388-2208 | |
| (931) 454-9499 | |
| (931) 454-9499 |
| Full Name | Petty Dental, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2118 N Jackson St, Tullahoma, Tennessee |
| Authorized Official Name and Position | Jackson Petty (OWNER) |
| Authorized Official Contact | 9314549499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Petty Dental, Pllc 2118 N Jackson St Tullahoma TN 37388-2208 Ph: (931) 454-9499 | Petty Dental, Pllc 2118 N Jackson St Tullahoma TN 37388-2208 Ph: (931) 454-9499 |
| NPI Number | 1215747100 |
|---|---|
| Provider Enumeration Date | 01/13/2025 |
| Last Update Date | 01/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215747100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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