Provider Demographics
NPI:1649764598
Name:GIRSON, ANNIE (DDS)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:GIRSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16000 PRESTON RD. SUITE 310
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-386-6460
Mailing Address - Fax:
Practice Address - Street 1:16000 PRESTON RD. SUITE 310
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248
Practice Address - Country:US
Practice Address - Phone:972-386-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice