| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 601 E Dodge St, Tyler, Texas |
| Authorized Official Name and Position | Cintia Rodaway (MANAGER) |
| Authorized Official Contact | 9035085750 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
601 E Dodge St Tyler TX 75701-1812 Ph: () - | 601 E Dodge St Tyler TX 75701-1812 Ph: (903) 508-5750 |
| NPI Number | 1356168538 |
|---|---|
| Provider Enumeration Date | 09/20/2024 |
| Last Update Date | 10/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356168538 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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