Provider Demographics
NPI:1053549162
Name:DECK, JENNIFER PITZ (DDS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PITZ
Last Name:DECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 FLAT CREEK PL
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2318
Mailing Address - Country:US
Mailing Address - Phone:214-865-8991
Mailing Address - Fax:
Practice Address - Street 1:3000 GASTON AVE.
Practice Address - Street 2:STE 504C
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226
Practice Address - Country:US
Practice Address - Phone:214-828-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00245551223G0001X
TX0245551223P0221X
TX245551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice