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General NPI Number Information
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NPI Number | 1467511642
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Entity Type | Individual
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Provider Name | DOLPHUS CARL JACKSON D.D.S., P.C.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 4012 OHALLORN DR STE A
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City | SPRING HILL
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State | TN
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Zip | 37174-2214
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Country | US
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Telephone | 615-302-8471
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Fax | 615-302-8081
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Provider Business Mailing Address
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Address Line | 4012 OHALLORN DR STE A
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City | SPRING HILL
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State | TN
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Zip | 37174-2214
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Country | US
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Telephone | 615-302-8471
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Fax | 615-302-8081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS08035
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS0000008035
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License Number State | TN
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