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Organization
TIMES SQUARE FAMILY DENTAL PA
Active
Organization
TIMES SQUARE FAMILY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAIVAN KEVIN AFKHAMI DDS (PRESIDENT)
(817) 577-9200
Entity
Organization
Contact information
Practice address
5201 S BROADWAY AVE, SUITE 240, TYLER, TX 75703-3748
(903) 534-8110
(903) 534-5510
Mailing address
1801 PRECINCT LINE RD STE A, HURST, TX 76054-3171
(817) 577-9200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20467
TX
Other
Enumeration date
12/11/2013
Last updated
12/11/2013
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