| J Lee Pettigrew Dds Pa | |
|
201 Players Cir Ste 100 Southlake TX 76092-6944 | |
| (817) 481-4888 | |
| (817) 421-7370 |
| Full Name | J Lee Pettigrew Dds Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 201 Players Cir, Southlake, Texas |
| Authorized Official Name and Position | Jerry Lee Pettigrew (OWNER) |
| Authorized Official Contact | 8174814888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J Lee Pettigrew Dds Pa 201 Players Cir Ste 100 Southlake TX 76092-6944 Ph: (817) 481-4888 | J Lee Pettigrew Dds Pa 201 Players Cir Ste 100 Southlake TX 76092-6944 Ph: (817) 481-4888 |
| NPI Number | 1619364114 |
|---|---|
| Provider Enumeration Date | 04/22/2015 |
| Last Update Date | 04/22/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619364114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 15943 (Texas) | Primary |
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