Individual
CULBERSON REEVES BOREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
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
013063
TX
1223P0221X
Pediatric Dentistry
13063
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008045901
—
TX
01
—
751899269
TAX ID
TX
Enumeration date
10/19/2006
Last updated
08/16/2012
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