| Times Square Family Dental Pa | |
|
5201 S Broadway Ave Suite 240 Tyler TX 75703-3748 | |
| (903) 534-8110 | |
| (903) 534-5510 |
| Full Name | Times Square Family Dental Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5201 S Broadway Ave, Tyler, Texas |
| Authorized Official Name and Position | Kaivan Kevin Afkhami (PRESIDENT) |
| Authorized Official Contact | 8175779200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Times Square Family Dental Pa 1801 Precinct Line Rd Ste A Hurst TX 76054-3171 Ph: (817) 577-9200 | Times Square Family Dental Pa 5201 S Broadway Ave Suite 240 Tyler TX 75703-3748 Ph: (903) 534-8110 |
| NPI Number | 1174954424 |
|---|---|
| Provider Enumeration Date | 12/11/2013 |
| Last Update Date | 12/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174954424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Texas) | Primary |
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