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132 S Horace Ave Tyler TX 75702-6159 | |
| (903) 593-7607 | |
| (903) 593-3965 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 132 S Horace Ave, Tyler, Texas |
| Authorized Official Name and Position | David Young (CEO) |
| Authorized Official Contact | 9035319455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
132 S Horace Ave Tyler TX 75702-6159 Ph: (903) 593-7607 | 132 S Horace Ave Tyler TX 75702-6159 Ph: (903) 593-7607 |
| NPI Number | 1467689307 |
|---|---|
| Provider Enumeration Date | 06/18/2009 |
| Last Update Date | 03/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467689307 | NPI | - | NPPES |
| 203763201 | Medicaid | TX | |
| G6063601 | Other | TX | DELTA DENTAL- CHIPS |
| 203763202 | Other | TX | MEDICAID-CSCHN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | 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 | |