Provider Demographics
NPI:1154197085
Name:TYLER DENTURE PROS, PLLC
Entity type:Organization
Organization Name:TYLER DENTURE PROS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:KHRYSTINE
Authorized Official - Last Name:PRINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-591-8670
Mailing Address - Street 1:921 SHILOH RD STE C100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1405
Mailing Address - Country:US
Mailing Address - Phone:903-258-6099
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD STE C100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1405
Practice Address - Country:US
Practice Address - Phone:903-258-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental