Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 0024555 | TX |
N | 213EG0000X | General Practice | 0024555 | TX |
N | 1223P0221X | Pediatric Dentist | 024555 | TX |
Y | 1223P0221X | Pediatric Dentist | 24555 | TX |
NPI | 1053549162 |
---|---|
Provider Name | Jennifer Pitz Deck |
First Address | Richardson, TX 75080-2318 |
Second Address | Dallas, TX 75226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 11/06/2021 |