| Azalea Dental Care | |
|
110 E. Ninth Street Tyler TX 75701 | |
| (903) 593-6585 | |
| (903) 593-7645 |
| Full Name | Azalea Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 110 E. Ninth Street, Tyler, Texas |
| Authorized Official Name and Position | Matthew Hans Gillespie (PRESIDENT) |
| Authorized Official Contact | 9035936585 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Azalea Dental Care 110 E. Ninth Street Tyler TX 75701 Ph: (903) 593-6585 | Azalea Dental Care 110 E. Ninth Street Tyler TX 75701 Ph: (903) 593-6585 |
| NPI Number | 1851652291 |
|---|---|
| Provider Enumeration Date | 06/01/2012 |
| Last Update Date | 02/18/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851652291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | 25547 (Texas) | Primary |
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