Organization · NPI-2

Affordable Dentist Near Me Tyler

Dentist, General Practice · Tyler, TX

NPI number1356168538
StatusActive
Last updated in NPPESOct 18, 2024

Details

NPI
1356168538
Entity type
Organization (NPI-2)
Legal business name
Affordable Dentist Near Me Tyler
Organization subpart
No
Enumeration date
Sep 20, 2024
Certification date
Oct 18, 2024
Last updated
Oct 18, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes
261QD0000X Clinic/Center, Dental––

Other names

  • Affordable Dentist Near Me Tyler (Doing Business As)

Practice location

601 E Dodge St
Tyler, TX 75701-1812

Phone 903-508-5750

Mailing address

601 E Dodge St
Tyler, TX 75701-1812

Authorized official

Cintia Rodaway
Manager
9035085750

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