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5011 Troup Hwy # 700 Tyler TX 75707-1917 | |
| (903) 581-5500 | |
| (903) 581-5510 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5011 Troup Hwy # 700, Tyler, Texas |
| Authorized Official Name and Position | Emily Brasher (OFFICE MANAGER) |
| Authorized Official Contact | 9035815500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5011 Troup Hwy # 700 Tyler TX 75707-1917 Ph: (903) 581-5500 | 5011 Troup Hwy # 700 Tyler TX 75707-1917 Ph: (903) 581-5500 |
| NPI Number | 1699032169 |
|---|---|
| Provider Enumeration Date | 04/20/2012 |
| Last Update Date | 04/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699032169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18962 (Texas) | Primary |
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