|
| |
|
3805 Brookside Dr Tyler TX 75701-9421 | |
| (903) 581-2900 | |
| (903) 509-0160 |
| Full Name | |
|---|---|
| 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 |
|---|---|
3805 Brookside Dr Tyler TX 75701-9421 Ph: (903) 581-2900 | 3805 Brookside Dr Tyler TX 75701-9421 Ph: (903) 581-2900 |
| NPI Number | 1619331634 |
|---|---|
| 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 |
Kim Fretty Orthodontics Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6989 Highlands Ln, Tyler, TX 75703 Phone: 903-561-7873 | |
Pediatric Dentistry Of Tyler, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3607 Old Jacksonville Rd, Tyler, TX 75701 Phone: 903-595-5476 | |