Alpha First Dental Clinic P.a
Organization Active NPI General Practice Dentistry · Tyler, TX
NPI 1720325418 · NPPES record last updated Jul 29, 2020
Key facts
- NPI
- 1720325418
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 20172 (TX)
- Legal business name
- ALPHA FIRST DENTAL CLINIC P.A
- Practice address
- 5605 Old Bullard Rd Ste a
Tyler, TX 75703-4306 - Phone
- (903) 747-3919
- Fax
- (903) 212-4210
- NPI assigned
- Jan 15, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Omowumi Akhuini Ihionkhan, DDS
- Title
- Dentist/Director
- Phone
- (903) 242-9777
Corporate family (same tax ID) 3
Practitioners 1
-
Mazen Atout, DMD
National Provider Directory
- Tax ID family
- Alpha First Dental Clinic PA
Locations
5605 Old Bullard Rd
#A
Tyler, TX 75703
Phone (903) 747-3919
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 20172 | TX | Yes |
Addresses
Primary practice location
5605 Old Bullard Rd Ste a
Tyler, TX 75703-4306
Mailing address
5605 Old Bullard Rd Ste a
Tyler, TX 75703-4306
Phone (903) 747-3919
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3140113-01 | Medicaid | TX |
Other providers in Tyler, TX
- Rebecca Allison
- Tracy Paulette Allison
- Muhammad Almas
- Julieta Boydon Almazan
- Melissa Ines Almodovar-Irizarry
- Danielle Altenbaumer
- Alva Alford
- Latasha Alvarado
- Vanessa Alvarado
- Alyzabeth Alvarez
All providers in Tyler, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.