|
| |
|
5011 Troup Hwy # 700 Tyler TX 75707-1917 | |
| (903) 581-5500 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5011 Troup Hwy # 700, Tyler, Texas |
| Authorized Official Name and Position | William Robert Jennings (OWNER) |
| 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 | 1972812667 |
|---|---|
| Provider Enumeration Date | 09/29/2010 |
| Last Update Date | 09/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972812667 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18962 (Texas) | 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 | |