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St Paul Children's Medical Corporation
Pediatric Dentist in Tyler, Texas
NPI 1467689307

St Paul Children's Medical Corporation is a Pediatric Dentist based in Tyler, TX and is specialized in Pediatric Dentistry. St Paul Children's Medical Corporation practices in Tyler, TX. The NPI Number for St Paul Children's Medical Corporation is 1467689307 and holds a License No. (Texas).

The current practice location address for St Paul Children's Medical Corporation is 132 S Horace Ave, Tyler, TX and can be reached out via phone at 903-593-7607 and via fax at 903-593-3965.

Location: 132 S Horace Ave, Tyler, TX, 75702-6159
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1467689307
Provider Name
St Paul Children's Medical Corporation
Credential
Provider Entity Type
Organization
Address
132 S Horace Ave, Tyler, TX, 75702-6159
Phone Number
903-593-7607
Fax Number
903-593-3965
Provider Enumeration Date
06/18/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
203763201 05 TX
G6063601 01 TX DELTA DENTAL- CHIPS
203763202 01 TX MEDICAID-CSCHN
institution
Provider Business Practice Location Address Details
Address
132 S Horace Ave
City
Tyler
State
Texas
Zip
75702-6159
Phone Number
903-593-7607
Fax Number
903-593-3965
person
Provider Business Mailing Address Details
Address
132 S Horace Ave
City
Tyler
State
Texas
Zip
75702-6159
Phone Number
903-593-7607
Fax Number
903-593-3965
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
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Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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