Provider Demographics
NPI:1134449945
Name:BOOZER-LINDSEY PA
Entity type:Organization
Organization Name:BOOZER-LINDSEY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-597-2121
Mailing Address - Street 1:PO BOX 9499
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9499
Mailing Address - Country:US
Mailing Address - Phone:903-675-0023
Mailing Address - Fax:903-675-0024
Practice Address - Street 1:6300 STATE HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-8966
Practice Address - Country:US
Practice Address - Phone:903-675-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213370401Medicaid