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General NPI Number Information
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NPI Number | 1386564136
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Entity Type | Organization
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Legal Business Name | EWING JACKSON THREET, II, DMD, MSD, PLLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 319 BLUE PEACOCK WAY STE 1
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City | SEYMOUR
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State | TN
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Zip | 37865-3924
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Country | US
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Telephone | 865-280-2526
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Fax |
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Provider Business Mailing Address
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Address Line | 1364 DISTRICT LN APT 459
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City | CHATTANOOGA
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State | TN
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Zip | 37406-1946
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Country | US
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Telephone | 704-390-6628
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Fax |
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Authorized Official
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Title or Position | OWNER / ENDODONTIST
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Name | EWING JACKSON THREET II
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Credential | DMD
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Telephone | 704-390-6628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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