Provider Demographics
NPI:1558660662
Name:PETTIT, NATHAN JAMES (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JAMES
Last Name:PETTIT
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FANNIN ST STE 880
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1911
Mailing Address - Country:US
Mailing Address - Phone:713-790-0531
Mailing Address - Fax:713-790-0725
Practice Address - Street 1:7400 FANNIN ST STE 880
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1911
Practice Address - Country:US
Practice Address - Phone:713-790-0531
Practice Address - Fax:713-790-0725
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27005122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist