# J LEE PETTIGREW DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619364114
- **Authorized official:** DR. JERRY LEE PETTIGREW JR. DDS (OWNER)
- **Authorized official phone:** (817) 481-4888

## Contact information

- **Practice address:** 201 PLAYERS CIR, STE 100, SOUTHLAKE, TX 76092-6944
- **Practice address phone:** (817) 481-4888
- **Practice address fax:** (817) 421-7370
- **Mailing address:** 201 PLAYERS CIR, STE 100, SOUTHLAKE, TX 76092-6944
- **Mailing address phone:** (817) 481-4888
- **Mailing address fax:** (817) 421-7370

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 15943 | TX | Yes |

## Other

- **Enumeration date:** 04/22/2015
- **Last updated:** 04/22/2015