Organization
EAST TEXAS DENTAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVE W LEBO D.D.S. (OWNER)
(903) 509-0505
Entity
Organization
Contact information
Practice address
212 OLD GRANDE BLVD, SUITE B224, TYLER, TX 75703-4264
(903) 509-0505
(903) 509-0506
Mailing address
212 OLD GRANDE BLVD, SUITE B224, TYLER, TX 75703-4264
(903) 509-0505
(903) 509-0506
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12586
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007885903
—
TX
01
—
1902910920
INDIVIDUAL NPI
TX
Enumeration date
03/11/2010
Last updated
03/11/2010
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