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Organization
TATE FAMILY DENTISTRY, PA
Active
Organization
TATE FAMILY DENTISTRY, PA
Active
Other names
John Michael Tate DDS Pa
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN TYLER TATE D.D.S. (SECRETARY)
(817) 481-6364
Entity
Organization
Contact information
Practice address
3101 E STATE HIGHWAY 114, STE A, SOUTHLAKE, TX 76092-6690
(817) 481-6364
(817) 329-2296
Mailing address
3101 E STATE HIGHWAY 114, STE A, SOUTHLAKE, TX 76092-6690
(817) 481-6364
(817) 329-2296
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
TX11540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TX11540
DENTAL LICENSE NUMBER
TX
01
—
TX26565
DENTAL LICENSE NUMBER
TX
Enumeration date
06/15/2005
Last updated
12/15/2014
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