East Texas Dental Group, Llc

LBN: East Texas Dental Group, Llc
East Texas Dental Group, Llc is an health care organization with primary practice located at 212 Old Grande Blvd B224, Tyler TX 75703-4226. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. East Texas Dental Group, Llc can be contacted via phone (903) 509-0505, or through Shim, Young T via phone (903) 509-0505.

Contact Information

Primary practice address
212 Old Grande Blvd B224 Tyler TX 75703-4226
Phone: (903) 509-0505
Fax: (903) 509-0506
Website:
Map and Directions
Authorized official contact:
Name: Shim, Young T Doctor of Dental Medicine (DMD)
Phone: (903) 509-0505

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 31033 Texas

Profile Details

NPI number 1750743167
LBN Legal business name East Texas Dental Group, Llc
DBA Doing business as
Authorized official Shim, Young T Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 24th, 2016
Last updated Mar 24th, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750743167 NPPES
Texas MEDICAID 352003301

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