Fresh Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

FRESH DENTAL PLLC

Practice address

3873 Hwy 64 W
Tyler, TX 75704-6925

Phone

(972) 869-3789

NPI assigned

Jun 9, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Pu

Title

Cfo

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Fresh Dental & Orthodontics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alan Anderson

  • Dentist
  • Tyler, TX
  • NPI 1952715377
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1093000804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3873 HWY 64 W",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757046925",
            "telephone_number": "972-869-3789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "PU",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fresh Dental & Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Lee Freeze, DC
• Gregory L Freimer, MD
• Kassidy French
• Robert Xavier French, DO
• Wade E French, ED.D., LPC
• Lori Ann Fried, FNP-C
• Jessica Friend
• Charles T Fries, EDD
• Barry Frizzell, LAT, ATC, PTA, CSCS
• Tyson Frodsham

• Dentist in Tyler, TX
• Providers in Tyler, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.