Organization
MATTHEW D GRACE DDS, PLLC
Active
Other names
Broadway Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW D GRACE DDS (DENTIST)
(903) 316-9419
Entity
Organization
Contact information
Practice address
5621 S BROADWAY AVE, TYLER, TX 75703-4348
(903) 630-6313
Mailing address
353 VZCR 1519, GRAND SALINE, TX 75140-5744
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/06/2018
Last updated
12/06/2018
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