Organization
ALPHA FIRST DENTAL CLINIC P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMOWUMI AKHUINI IHIONKHAN DDS (DENTIST/DIRECTOR)
(903) 242-9777
Entity
Organization
Contact information
Practice address
5605 OLD BULLARD RD STE A, TYLER, TX 75703-4306
(903) 747-3919
(903) 212-4210
Mailing address
5605 OLD BULLARD RD STE A, TYLER, TX 75703-4306
(903) 747-3919
(903) 212-4210
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20172
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3140113-01
—
TX
Enumeration date
01/15/2013
Last updated
07/29/2020
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