| Professional Dental Alliance Of Tx 43004 Pllc | |
|
212 Old Grande Blvd Ste B224 Tyler TX 75703-4277 | |
| (903) 509-0505 | |
| Not Available |
| Full Name | Professional Dental Alliance Of Tx 43004 Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 212 Old Grande Blvd Ste B224, Tyler, Texas |
| Authorized Official Name and Position | Lauren Howard (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7575765479 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Alliance Of Tx 43004 Pllc 11 S Mill St New Castle PA 16101-3680 Ph: () - | Professional Dental Alliance Of Tx 43004 Pllc 212 Old Grande Blvd Ste B224 Tyler TX 75703-4277 Ph: (903) 509-0505 |
| NPI Number | 1093329534 |
|---|---|
| Provider Enumeration Date | 09/02/2020 |
| Last Update Date | 09/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093329534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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