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Organization
TY BLACK DDS
Active
Organization
TY BLACK DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA BLACK (OFF MGR)
(903) 534-8110
Entity
Organization
Contact information
Practice address
5201 S BROADWAY AVE, ST 240, TYLER, TX 75703
(903) 534-8110
(903) 534-5510
Mailing address
5201 S BROADWAY AVE, ST 240, TYLER, TX 75703-3748
(903) 534-8110
(903) 534-5510
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20648
TX
Other
Enumeration date
05/11/2009
Last updated
05/11/2009
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