| Brick Street Dental, Pllc | |
|
215 W Rusk St Tyler TX 75701-1652 | |
| (903) 592-8411 | |
| (903) 592-8454 |
| Full Name | Brick Street Dental, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 215 W Rusk St, Tyler, Texas |
| Authorized Official Name and Position | James Coker Morrison (MANAGER) |
| Authorized Official Contact | 9035928411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brick Street Dental, Pllc 215 W Rusk St Tyler TX 75701-1652 Ph: (903) 592-8411 | Brick Street Dental, Pllc 215 W Rusk St Tyler TX 75701-1652 Ph: (903) 592-8411 |
| NPI Number | 1730623950 |
|---|---|
| Provider Enumeration Date | 12/07/2016 |
| Last Update Date | 12/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730623950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 12678 (Texas) | Primary |
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