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8942 S Broadway Ave Ste 128 Tyler TX 75703-5443 | |
(903) 594-4562 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 8942 S Broadway Ave Ste 128, Tyler, Texas |
Authorized Official Name and Position | Jenny Garcia (CREDENTIALING LEAD) |
Authorized Official Contact | 9728693789 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 734753 Dallas TX 75373-4753 Ph: (972) 869-3789 | 8942 S Broadway Ave Ste 128 Tyler TX 75703-5443 Ph: (903) 594-4562 |
NPI Number | 1548636061 |
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Provider Enumeration Date | 08/19/2015 |
Last Update Date | 11/21/2022 |
Identifier | Type | State | Issuer |
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1548636061 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | (* (Not Available)) | Primary |
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