Provider Demographics
NPI:1134502461
Name:PRITCHETT, TASHEKA NOVONN (DDS)
Entity Type:Individual
Prefix:
First Name:TASHEKA
Middle Name:NOVONN
Last Name:PRITCHETT
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 1:1800 MAIN ST APT 1052
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-5220
Mailing Address - Country:US
Mailing Address - Phone:915-383-9946
Mailing Address - Fax:
Practice Address - Street 1:1800 MAIN ST APT 1052
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-5220
Practice Address - Country:US
Practice Address - Phone:915-383-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311071223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice