is a Pediatric Dental Clinic in Tyler, Texas. It is located at 7916 S Broadway Ave, Ste 150, Tyler, TX and its contact number is 903-581-2198. The authorized person for is Culberson Reeves Boren
who is Owner/ Dentist of the clinic and their contact number is 903-581-2198. The primary license number for is 13063 (Pediatric Dentistry) in Texas. Clinic provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
Complete Clinic Profile:
Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
Name:
Specialization:
Pediatric Dentistry
Clinic Address:
7916 S Broadway Ave, Ste 150, Tyler, Texas, 75703-5274
Phone:
903-581-2198
Fax:
903-581-9571
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
Name:
Culberson Reeves Boren
Position:
Owner/ Dentist
Contact Number:
903-581-2198
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for clinic are as mentioned below.
NPI Number:
1033411962
NPI Enumeration Date:
29 Nov, 2010
NPI Last Update On:
14 Aug, 2012
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for are as mentioned below.
Specialization
License Number
State
Status
Pediatric Dentistry
13063
Texas
Primary
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
008045901
Medicaid
Texas
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
7916 S Broadway Ave, Ste 150 Tyler, Texas
Zip:
75703-5274
Phone Number:
903-581-2198
Fax Number:
903-581-9571
Patients can reach at 7916 S Broadway Ave, Ste 150, Tyler, Texas or can call to book an appointment on 903-581-2198. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 February, 2025.