Provider Demographics
NPI:1639305402
Name:PUCKETT, BILLY (DDS)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:PUCKETT
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 1:6081 TRENT CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8498 SOUTH HOUSTON SAM HOUSTON PARKWAY
Practice Address - Street 2:600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075
Practice Address - Country:US
Practice Address - Phone:281-799-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00246771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice