Organization · NPI-2

Alpha First Dental Clinic P.A

Dentist, General Practice · Tyler, TX

NPI number1720325418
StatusActive
Last updated in NPPESJul 29, 2020

Details

NPI
1720325418
Entity type
Organization (NPI-2)
Legal business name
Alpha First Dental Clinic P.A
Organization subpart
No
Enumeration date
Jan 15, 2013
Certification date
Jul 29, 2020
Last updated
Jul 29, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice20172TXYes

Practice location

5605 Old Bullard Rd Ste A
Tyler, TX 75703-4306

Phone 903-747-3919 · Fax 903-212-4210

Mailing address

5605 Old Bullard Rd Ste A
Tyler, TX 75703-4306

Phone 903-747-3919 · Fax 903-212-4210

Authorized official

Omowumi Akhuini Ihionkhan
Dentist/Director
9032429777

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