East Texas Dental Group, Llc is a Dental Clinic in Tyler, Texas. It is located at 212 Old Grande Blvd, B224, Tyler, TX and its contact number is 903-509-0505. The authorized person for East Texas Dental Group, Llc is Dr. Young T Shim
who is Owner of the clinic and their contact number is 903-509-0505. Other organizations associated with this clinic are East Texas Dental Associates, P.a., East Texas Dental Group, Llc, The primary license number for East Texas Dental Group, Llc is 31033 (Dentist) in Texas.
East Texas Dental Group, Llc Clinic have dental surgeons who are specialized in dentistry, diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.
Complete Clinic Profile:
East Texas Dental Group, Llc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | East Texas Dental Group, Llc |
| Specialization: | Dentistry |
| Clinic Address: | 212 Old Grande Blvd, B224, Tyler,
Texas, 75703-4226 |
| Phone: | 903-509-0505 |
| Fax: | 903-509-0506 |
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: | Dr. Young T Shim |
| Position: | Owner |
| Contact Number: | 903-509-0505 |
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 East Texas Dental Group, Llc clinic are as mentioned below.
| NPI Number: | 1750743167 |
| NPI Enumeration Date: | 24 Mar, 2016 |
| NPI Last Update On: | 24 Mar, 2016 |
Other Associated Organizations:
Other organizations which are associated with this clinic are as mentioned below. These organization share the same address but have similar or different specialization.
Speciality of these organizations are also mentioned below.
| Name | Specialization | NPI Number |
| East Texas Dental Associates, P.a. | Dentistry | 1750604211 |
| East Texas Dental Group, Llc | Dentistry | 1750743167 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for East Texas Dental Group, Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Dentist | 31033 | 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 |
| 352003301 | 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: | East Texas Dental Group, Llc
212 Old Grande Blvd, Suite B224
Tyler, Texas |
| Zip: | 75703-4226 |
| Phone Number: | 903-509-0505 |
| Fax Number: | 903-509-0506 |
Patients can reach East Texas Dental Group, Llc at
212 Old Grande Blvd, B224, Tyler, Texas or can
call to book an appointment on 903-509-0505.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.