Healthcare Provider Details

I. General information

NPI: 1801406129
Provider Name (Legal Business Name): JACOB PERRY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2020
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 VETERANS PKWY
MURFREESBORO TN
37128-1076
US

IV. Provider business mailing address

10706 EAGLE GLEN DR
KNOXVILLE TN
37922-5566
US

V. Phone/Fax

Practice location:
  • Phone: 615-713-1993
  • Fax:
Mailing address:
  • Phone: 801-319-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11662
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: