Provider Demographics
NPI:1356168538
Name:AFFORDABLE DENTIST NEAR ME TYLER
Entity type:Organization
Organization Name:AFFORDABLE DENTIST NEAR ME TYLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-508-5750
Mailing Address - Street 1:601 E DODGE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 E DODGE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1812
Practice Address - Country:US
Practice Address - Phone:903-508-5750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty