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5540 Old Jacksonville Hwy Tyler TX 75703-3378 | |
| (903) 597-2121 | |
| (903) 581-7776 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5540 Old Jacksonville Hwy, Tyler, Texas |
| Authorized Official Name and Position | Kent B Boozer (DENTIST/OWNER) |
| Authorized Official Contact | 9035972121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5540 Old Jacksonville Hwy Tyler TX 75703-3378 Ph: (903) 597-2121 | 5540 Old Jacksonville Hwy Tyler TX 75703-3378 Ph: (903) 597-2121 |
| NPI Number | 1508046129 |
|---|---|
| Provider Enumeration Date | 11/12/2007 |
| Last Update Date | 11/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508046129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 20107 (Texas) | Primary |
Kim Fretty Orthodontics Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6989 Highlands Ln, Tyler, TX 75703 Phone: 903-561-7873 | |
Pediatric Dentistry Of Tyler, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3607 Old Jacksonville Rd, Tyler, TX 75701 Phone: 903-595-5476 | |