| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 3873 Hwy 64 W, Tyler, Texas |
| Authorized Official Name and Position | Mary Pu (CFO) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 734753 Dallas TX 75373-4753 Ph: (972) 869-3789 | 3873 Hwy 64 W Tyler TX 75704-6925 Ph: (972) 869-3789 |
| NPI Number | 1093000804 |
|---|---|
| Provider Enumeration Date | 06/09/2011 |
| Last Update Date | 04/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093000804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | 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 |