Tyler Periodontics, PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

30701 Issued in TX

Legal business name

TYLER PERIODONTICS, PLLC

Practice address

3805 Brookside Dr
Tyler, TX 75701-9421

Phone

(903) 581-2900

Fax

(903) 509-0160

NPI assigned

Apr 6, 2016

Last updated

Dec 22, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Rhonda Worthen

Title

Business Manager

Phone

(903) 581-2900

Specialties & licenses 2

Addresses

Other names 1

• John E. Adcock DDS MS Former legal business name

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John E. Adcock, D.D.S., M.S.

  • Periodontics
  • Tyler, TX
  • NPI 1922005503
  NPD (past)
• Alexandra Ricker Kennedy, DDS, MS

  • Periodontics
  • Tyler, TX
  • NPI 1891347951
  NPD (past)
• Kayleigh Eaves Temple, DDS

  • Periodontics
  • Tyler, TX
  • NPI 1396009148
  NPD (past)

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1619331634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 BROOKSIDE DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019421",
            "telephone_number": "903-581-2900",
            "fax_number": "903-509-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 BROOKSIDE DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019421",
            "telephone_number": "903-581-2900",
            "fax_number": "903-509-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER PERIODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "WORTHEN",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "903-581-2900",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "30701",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "10911",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John E. Adcock DDS MS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Tyler Office of Pediatrics P a
• Tyler Optical Lab Inc (barrett opticians)
• Tyler Oral & Facial Surgery Inc.
• Tyler Orthodontics, PLLC
• Tyler Orthopedic Specialists PA
• Tyler Physical Medicine Associates PA
• Tyler Physician Services, PLLC
• Tyler Professional Surgical Associate
• Tyler Prosthetics Inc
• Tyler Psychology Group LLP (Clinical Associates of East Texas)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.