| Ikids Pediatric Dentistry Tyler, Pllc | |
|
3607 Old Jacksonville Rd Tyler TX 75701 | |
| (903) 595-5476 | |
| Not Available |
| Full Name | Ikids Pediatric Dentistry Tyler, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3607 Old Jacksonville Rd, Tyler, Texas |
| Authorized Official Name and Position | Alyssa Aguilar (DIRECTOR OF REVENUE & CREDENTIALING) |
| Authorized Official Contact | 8174668554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikids Pediatric Dentistry Tyler, Pllc 2500 E Broad St Ste 204 Mansfield TX 76063-4361 Ph: (817) 466-8554 | Ikids Pediatric Dentistry Tyler, Pllc 3607 Old Jacksonville Rd Tyler TX 75701 Ph: (903) 595-5476 |
| NPI Number | 1699281782 |
|---|---|
| Provider Enumeration Date | 12/27/2017 |
| Last Update Date | 03/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699281782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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