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1698 Grande Blvd Tyler TX 75703-4426 | |
| (903) 266-9118 | |
| (903) 266-9126 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1698 Grande Blvd, Tyler, Texas |
| Authorized Official Name and Position | Kyle N Hampton (OWNER) |
| Authorized Official Contact | 9032669118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1698 Grande Blvd Tyler TX 75703-4426 Ph: (903) 266-9118 | 1698 Grande Blvd Tyler TX 75703-4426 Ph: (903) 266-9118 |
| NPI Number | 1063727428 |
|---|---|
| Provider Enumeration Date | 08/10/2010 |
| Last Update Date | 08/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063727428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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