Healthcare Provider Details

I. General information

NPI: 1467511642
Provider Name (Legal Business Name): DOLPHUS CARL JACKSON D.D.S., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 OHALLORN DR STE A
SPRING HILL TN
37174-2214
US

IV. Provider business mailing address

4012 OHALLORN DR STE A
SPRING HILL TN
37174-2214
US

V. Phone/Fax

Practice location:
  • Phone: 615-302-8471
  • Fax: 615-302-8081
Mailing address:
  • Phone: 615-302-8471
  • Fax: 615-302-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS08035
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS0000008035
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: