Alpha First Dental Clinic P.a | |
5605 Old Bullard Rd Ste A Tyler TX 75703-4306 | |
(903) 747-3919 | |
(903) 212-4210 |
Full Name | Alpha First Dental Clinic P.a |
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Speciality | Dentist - General Practice |
Location | 5605 Old Bullard Rd Ste A, Tyler, Texas |
Authorized Official Name and Position | Omowumi Akhuini Ihionkhan (DENTIST/DIRECTOR) |
Authorized Official Contact | 9032429777 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Alpha First Dental Clinic P.a 5605 Old Bullard Rd Ste A Tyler TX 75703-4306 Ph: (903) 747-3919 | Alpha First Dental Clinic P.a 5605 Old Bullard Rd Ste A Tyler TX 75703-4306 Ph: (903) 747-3919 |
NPI Number | 1720325418 |
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Provider Enumeration Date | 01/15/2013 |
Last Update Date | 07/29/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720325418 | NPI | - | NPPES |
3140113-01 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 20172 (Texas) | Primary |
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