Jackson Petty, DDS
NPI 1417565193ActiveIndividual· Dentist, General Practice· Tullahoma, TN
Dentist, General Practice (DDS) in Tullahoma, Tennessee, licensed in TN and CO, with an NPI issued in July 2020. Part D covered 13 prescriptions written in 2024, 85% of them generic.
Overview
| NPI | 1417565193 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DDS |
| Sole proprietor | No |
| NPI issued | Jul 17, 2020 |
| Last updated in NPPES | Jan 21, 2025 |
| Certified by provider | Jan 21, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | 11423 | TN |
| Dentist, General Practice | 1223G0001X | 204657 | CO |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Part D prescriptions in 2024
| Prescriptions (claims) | 13 · 13 30-day fills |
|---|---|
| Patients | 11 |
| Total drug cost | $54.54 |
| Generic share | 85% of claims |
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 20 general dentists in Tullahoma · All general dentists in Tennessee