DR. JACKSON PETTY DDS NPI 1417565193

NPI Information

NPI: 1417565193
Provider Name: DR. JACKSON PETTY, DDS
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

Address:
128 MARKET ST
ALAMOSA, CO
ZIP 81101
Phone: (719) 587-1001
Get Directions

DR. Jackson Petty, DDS is a general practice dentist in Alamosa, CO. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Jackson Petty, DDS NPI is 1417565193. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

128 MARKET ST
ALAMOSA, CO
ZIP 81101-290
Phone: (719) 587-1001
Fax: (719) 589-5722

The enumeration date for this NPI number is 7/17/2020 and was last updated on 7/19/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	204657	COLORADO	Yes
2	1223G0001X	Dentist	General Practice	11423	TENNESSEE	No
3	390200000X	Student in an Organized Health Care Education/Training Program				No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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