| Tate Family Dentistry, Pa | |
|
3101 E State Highway 114 Ste A Southlake TX 76092-6690 | |
| (817) 481-6364 | |
| (817) 329-2296 |
| Full Name | Tate Family Dentistry, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3101 E State Highway 114, Southlake, Texas |
| Authorized Official Name and Position | John Tyler Tate (SECRETARY) |
| Authorized Official Contact | 8174816364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tate Family Dentistry, Pa 3101 E State Highway 114 Ste A Southlake TX 76092-6690 Ph: (817) 481-6364 | Tate Family Dentistry, Pa 3101 E State Highway 114 Ste A Southlake TX 76092-6690 Ph: (817) 481-6364 |
| NPI Number | 1003811100 |
|---|---|
| Provider Enumeration Date | 06/15/2005 |
| Last Update Date | 12/15/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003811100 | NPI | - | NPPES |
| TX26565 | Other | TX | DENTAL LICENSE NUMBER |
| TX11540 | Other | TX | DENTAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | TX11540 (Texas) | Primary |
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