Provider Demographics
NPI:1518063254
Name:PFAFFENBERGER, MARYLOU E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:E
Last Name:PFAFFENBERGER
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 1:1025 W HEBRON PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1120
Mailing Address - Country:US
Mailing Address - Phone:972-394-1611
Mailing Address - Fax:972-394-1643
Practice Address - Street 1:1025 W HEBRON PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1120
Practice Address - Country:US
Practice Address - Phone:972-394-1611
Practice Address - Fax:972-394-1643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX192931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice