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419 W Sw Loop 323 Ste 300 Tyler TX 75701-7062 | |
(903) 251-9292 | |
(903) 207-8642 |
Full Name | |
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Speciality | Dentist - Pediatric Dentistry |
Location | 419 W Sw Loop 323 Ste 300, Tyler, Texas |
Authorized Official Name and Position | Dylan Patrick (MANAGING MEMBER) |
Authorized Official Contact | 9033633648 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2660 Barton Creek Cir Tyler TX 75703-7054 Ph: (903) 363-3648 | 419 W Sw Loop 323 Ste 300 Tyler TX 75701-7062 Ph: (903) 251-9292 |
NPI Number | 1871090860 |
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Provider Enumeration Date | 04/07/2018 |
Last Update Date | 06/11/2024 |
Identifier | Type | State | Issuer |
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1871090860 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Secondary |
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 | |