| Ty Black Dds | |
|
5201 S Broadway Ave St 240 Tyler TX 75703 | |
| (903) 534-8110 | |
| (903) 534-5510 |
| Full Name | Ty Black Dds |
|---|---|
| Speciality | Dentist |
| Location | 5201 S Broadway Ave, Tyler, Texas |
| Authorized Official Name and Position | Dana Black (OFF MGR) |
| Authorized Official Contact | 9035348110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ty Black Dds 5201 S Broadway Ave St 240 Tyler TX 75703-3748 Ph: (903) 534-8110 | Ty Black Dds 5201 S Broadway Ave St 240 Tyler TX 75703 Ph: (903) 534-8110 |
| NPI Number | 1437383015 |
|---|---|
| Provider Enumeration Date | 05/11/2009 |
| Last Update Date | 05/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437383015 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 20648 (Texas) | Primary |
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