PROFESSIONAL DENTAL ALLIANCE OF TX 43004 PLLC (NPI# 1093329534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093329534 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE OF TX 43004 PLLC |
| Practice Address |
212 Old Grande Blvd Ste B224 Tyler TX 75703-4277 |
| Mailing Address |
11 S Mill St New Castle PA 16101-3680 |
| Practice Telephone | 9035090505 |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |
| Authorized Official Name | LAUREN HOWARD (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 7575765479 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Street Address |
212 OLD GRANDE BLVD STE B224 |
| City | TYLER |
| State | TX |
| Zip Code | 75703-4277 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679183446 | Valerie Marie Cano | Dentist | 7223 Crosswater, Tyler, TX 75703-0719 | 2020-08-05 |
| 1033770227 | Rajamanoj Kondaveeti | Dentist | 3873 Tx-64, Tyler, TX 75704 | 2019-06-27 |
| 1538720016 | Trevor Justin Wortley | Dentist | 8942 S Broadway Ave Ste 128, Tyler, TX 75703-5443 | 2019-06-25 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1992217947 | Charles Cox IIi | Dentist | 1327 S Baxter Ave, Tyler, TX 75701-3404 | 2017-10-31 |
| 1326559022 | Blu Dental Group PC | Dentist | 3975 Old Jacksonville Rd, Tyler, TX 75701-8519 | 2017-10-20 |
| 1629598586 | Kunduru Dental Pllc | Dentist | 4164 S Broadway Ave, Tyler, TX 75701-8719 | 2017-06-22 |
| 1639549454 | Pine Creek Dental, Pllc | Dentist | 7925 S Broadway Ave Ste 300, Tyler, TX 75703-5227 | 2015-10-06 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.