J Lee Pettigrew DDS PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

15943 Issued in TX

Legal business name

J LEE PETTIGREW DDS PA

Practice address

201 Players Cir
Ste 100
Southlake, TX 76092-6944

Phone

(817) 481-4888

Fax

(817) 421-7370

NPI assigned

Apr 22, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry Lee Pettigrew Jr., DDS

Title

Owner

Phone

(817) 481-4888

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• J. Lee Pettigrew, D.D.S.

  • General Practice Dentistry
  • Southlake, TX
  • NPI 1477699031
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1619364114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PLAYERS CIR",
            "address_2": "STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926944",
            "telephone_number": "817-481-4888",
            "fax_number": "817-421-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 PLAYERS CIR",
            "address_2": "STE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926944",
            "telephone_number": "817-481-4888",
            "fax_number": "817-421-7370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J LEE PETTIGREW DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "PETTIGREW",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-481-4888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "15943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ironside Physical Therapy
• Irving Radiological Associates LLP
• Isidra Veve M.D. PLLC (Southlake Anesthesia)
• Amal Ismail
• Ivp, PLLC
• J&J Physical Therapy and Wellness (Inspire Physical Therapy and Wellness)
• Cordetta Lashawn Jackson
• Gabrielle Jackson
• Richard Jackson, MD
• Mrudul Rajan Jagtap, OTR/L

• Dental Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.