Organization
J LEE PETTIGREW DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY LEE PETTIGREW JR. DDS (OWNER)
(817) 481-4888
Entity
Organization
Contact information
Practice address
201 PLAYERS CIR, STE 100, SOUTHLAKE, TX 76092-6944
(817) 481-4888
(817) 421-7370
Mailing address
201 PLAYERS CIR, STE 100, SOUTHLAKE, TX 76092-6944
(817) 481-4888
(817) 421-7370
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
15943
TX
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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