| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 209 W 8th St, Tyler, Texas |
| Authorized Official Name and Position | William Robert Jennings (OWNER/DENTIST) |
| Authorized Official Contact | 9035973940 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2002 S Stemmons Fwy Ste 500 Lake Dallas TX 75065-3633 Ph: (940) 321-2053 | 209 W 8th St Tyler TX 75701-4102 Ph: (903) 597-3940 |
| NPI Number | 1255519575 |
|---|---|
| Provider Enumeration Date | 02/08/2008 |
| Last Update Date | 02/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255519575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 18962 (Texas) | Primary |
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