| Tyler Oral & Facial Surgery Inc. | |
|
805 Turtle Creek Dr Tyler TX 75701-1937 | |
| (903) 592-1664 | |
| (903) 525-1099 |
| Full Name | Tyler Oral & Facial Surgery Inc. |
|---|---|
| Speciality | Dentist |
| Location | 805 Turtle Creek Dr, Tyler, Texas |
| Authorized Official Name and Position | Makoto Saigusa (V-PRES.) |
| Authorized Official Contact | 9035921664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Oral & Facial Surgery Inc. 805 Turtle Creek Dr Tyler TX 75701-1937 Ph: (903) 592-1664 | Tyler Oral & Facial Surgery Inc. 805 Turtle Creek Dr Tyler TX 75701-1937 Ph: (903) 592-1664 |
| NPI Number | 1568654077 |
|---|---|
| Provider Enumeration Date | 08/17/2007 |
| Last Update Date | 01/23/2023 |
| Medicare PECOS PAC ID | 0446272306 |
|---|---|
| Medicare Enrollment ID | O20051220000984 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568654077 | NPI | - | NPPES |
| 195647603-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Secondary |
| Provider Name | Makoto Saigusa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1417067497 PECOS PAC ID: 7012983331 Enrollment ID: I20040910000566 |
| Provider Name | Jayson J Terres |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659448108 PECOS PAC ID: 1951346154 Enrollment ID: I20050627001458 |
| Provider Name | Kourt B Chatelain |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1366685810 PECOS PAC ID: 9436391521 Enrollment ID: I20130820000907 |
| Provider Name | Kristopher Lee Hasstedt |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1649511585 PECOS PAC ID: 8921350869 Enrollment ID: I20181004000838 |
| Provider Name | Ryan M Hinkle |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1558780460 PECOS PAC ID: 5092011551 Enrollment ID: I20200519001425 |
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