Provider Demographics
NPI:1669489043
Name:HANCOCK, JERRY LEONARD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEONARD
Last Name:HANCOCK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 RICHARD JONES RD
Mailing Address - Street 2:SUITE 103-A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2809
Mailing Address - Country:US
Mailing Address - Phone:615-383-0132
Mailing Address - Fax:615-292-0524
Practice Address - Street 1:2002 RICHARD JONES RD
Practice Address - Street 2:SUITE 103-A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2809
Practice Address - Country:US
Practice Address - Phone:615-383-0132
Practice Address - Fax:615-292-0524
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8516122300000X
GADN013185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist