Provider Demographics
NPI:1083988067
Name:WILLIAM J. TINNELL DDS INC.
Entity Type:Organization
Organization Name:WILLIAM J. TINNELL DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/DR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:TINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-325-4288
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:FALFURRIAS
Mailing Address - State:TX
Mailing Address - Zip Code:78355-0339
Mailing Address - Country:US
Mailing Address - Phone:361-325-4288
Mailing Address - Fax:361-325-5746
Practice Address - Street 1:1402 S ST MARYS ST STE C
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-5037
Practice Address - Country:US
Practice Address - Phone:361-325-4288
Practice Address - Fax:361-325-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008749602Medicaid