| Tyler Denture Pros, Pllc | |
|
921 Shiloh Rd Ste C100 Tyler TX 75703-1405 | |
| (903) 258-6099 | |
| Not Available |
| Full Name | Tyler Denture Pros, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 921 Shiloh Rd Ste C100, Tyler, Texas |
| Authorized Official Name and Position | Sarah Khrystine Prine (OWNER) |
| Authorized Official Contact | 2515918670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Denture Pros, Pllc 921 Shiloh Rd Ste C100 Tyler TX 75703-1405 Ph: (903) 258-6099 | Tyler Denture Pros, Pllc 921 Shiloh Rd Ste C100 Tyler TX 75703-1405 Ph: (903) 258-6099 |
| NPI Number | 1154197085 |
|---|---|
| Provider Enumeration Date | 12/01/2023 |
| Last Update Date | 12/01/2023 |
| Medicare PECOS PAC ID | 4981040458 |
|---|---|
| Medicare Enrollment ID | O20240307001158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154197085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Sarah Prine |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1649898354 PECOS PAC ID: 3274959036 Enrollment ID: I20240307001250 |
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