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Dr. Jackson Petty, DDS
General Practice Dentistry in Alamosa, Colorado
NPI 1417565193

Jackson Petty is a General Practice Dentistry based in Alamosa, CO and is specialized in General Practice. Jackson Petty practices in Alamosa, CO and has the professional credentials of DDS. The NPI Number for Jackson Petty is 1417565193 and holds a License No. 11423 (Colorado).

The current practice location address for Jackson Petty is 128 Market St, Alamosa, CO and can be reached out via phone at 719-587-1001 and via fax at 719-589-5722.

Location: 128 Market St, Alamosa, CO, 81101-2290
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1417565193
Provider Name
Jackson Petty
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
128 Market St, Alamosa, CO, 81101-2290
Phone Number
719-587-1001
Fax Number
719-589-5722
Provider Enumeration Date
07/17/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
128 Market St
City
Alamosa
State
Colorado
Zip
81101-2290
Phone Number
719-587-1001
Fax Number
719-589-5722
person
Provider Business Mailing Address Details
Address
128 Market St
City
Alamosa
State
Colorado
Zip
81101-2290
Phone Number
719-587-1001
Fax Number
719-589-5722
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
()
Definition
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.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
11423 (Tennessee)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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