Provider Demographics
NPI:1275663841
Name:PIETSCH, CARL FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:FRED
Last Name:PIETSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 E BELT LINE RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3748
Mailing Address - Country:US
Mailing Address - Phone:972-690-8617
Mailing Address - Fax:972-690-6423
Practice Address - Street 1:1231 E BELT LINE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3748
Practice Address - Country:US
Practice Address - Phone:972-690-8617
Practice Address - Fax:972-690-6423
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10482OtherSTATE LICENSE