Tyler Periodontics, Pllc | |
3805 Brookside Dr Tyler TX 75701-9421 | |
(903) 581-2900 | |
(903) 509-0160 |
Full Name | Tyler Periodontics, Pllc |
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Speciality | Dentist - Periodontics |
Location | 3805 Brookside Dr, Tyler, Texas |
Authorized Official Name and Position | Rhonda Worthen (BUSINESS MANAGER) |
Authorized Official Contact | 9035812900 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Tyler Periodontics, Pllc 3805 Brookside Dr Tyler TX 75701-9421 Ph: (903) 581-2900 | Tyler Periodontics, Pllc 3805 Brookside Dr Tyler TX 75701-9421 Ph: (903) 581-2900 |
NPI Number | 1619331634 |
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Provider Enumeration Date | 04/06/2016 |
Last Update Date | 12/22/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619331634 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0300X | Dentist - Periodontics | 30701 (Texas) | Primary |
1223P0300X | Dentist - Periodontics | 10911 (Texas) | Secondary |
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