Provider Demographics
NPI:1083264378
Name:KIM FRETTY ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:KIM FRETTY ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNEIL
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:FRETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-918-2519
Mailing Address - Street 1:6989 HIGHLANDS LN
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0639
Mailing Address - Country:US
Mailing Address - Phone:903-561-7873
Mailing Address - Fax:
Practice Address - Street 1:6989 HIGHLANDS LN
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0639
Practice Address - Country:US
Practice Address - Phone:903-561-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty