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General NPI Number Information
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NPI Number | 1053549162
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Entity Type | Individual
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Provider Name | JENNIFER PITZ DECK DDS
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Gender | Female
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 3000 GASTON AVE. STE 504C
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City | DALLAS
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State | TX
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Zip | 75226
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Country | US
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Telephone | 214-828-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 FLAT CREEK PL
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City | RICHARDSON
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State | TX
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Zip | 75080-2318
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Country | US
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Telephone | 214-865-8991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0024555
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 024555
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24555
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License Number State | TX
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