Organization
CULBERSON R. BOREN, D.D.S., P.A.
Active
Other names
Dentistry for Children
Organization subpart
No
Provider details
NPI number
Authorized official
CULBERSON REEVES BOREN DDS (OWNER/ DENTIST)
(903) 581-2198
Entity
Organization
Contact information
Practice address
7916 S BROADWAY AVE, STE 150, TYLER, TX 75703-5274
(903) 581-2198
(903) 581-9571
Mailing address
7916 S BROADWAY AVE, STE 150, TYLER, TX 75703-5274
(903) 581-2198
(903) 581-9571
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
13063
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008045901
—
TX
Enumeration date
11/29/2010
Last updated
08/14/2012
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