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General NPI Number Information
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NPI Number | 1730440934
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Entity Type | Individual
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Provider Name | TYSON K PICKETT D.D.S
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Gender | Male
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 07/04/2016
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Provider Practice Location Address
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Address Line | 1135 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-3614
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Country | US
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Telephone | 817-431-5514
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Fax | 801-431-8048
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Provider Business Mailing Address
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Address Line | 1135 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-3614
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Country | US
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Telephone | 817-431-5514
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Fax | 801-431-8048
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 5888464-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31668
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License Number State | TX
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