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PROFESSIONAL DENTAL ALLIANCE OF TX 43004 PLLC
NPI 1093329534
Dentist - General Practice in Tyler, TX

Active since September 02, 2020
212 OLD GRANDE BLVD STE B224, TYLER, TX 75703(903) 509-0505 Get Directions Write a Review

NPPES record last updated: September 2, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Professional Dental Alliance Of Tx 43004 Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROFESSIONAL DENTAL ALLIANCE OF TX 43004 PLLC (NPI 1093329534) is a healthcare organization registered as a general practice in Tyler, Texas and active in the NPI registry since September 2020. The organization lists Lauren Howard, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1093329534
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NamePROFESSIONAL DENTAL ALLIANCE OF TX 43004 PLLC
Location Address212 OLD GRANDE BLVD STE B224Tyler, TX 75703-4277
Mailing Address11 S Mill StNew Castle, PA 16101-3680
Phone(903) 509-0505
Organization SubpartNo
Authorized OfficialLauren HowardCredentialing Specialist · (757) 576-5479
Enumeration DateSeptember 2, 2020
NPPES CertifiedSeptember 2, 2020
✔ NPI 1093329534 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
212 OLD GRANDE BLVD STE B224, Tyler, TX 75703
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JUNG WON PARK DDS
Dentist
212 OLD GRANDE BLVD STE B224
TYLER, TX 75703
Smith County (903) 509-0505
NAGA AZZARAPU
Dentist
212 OLD GRANDE BLVD STE B224
TYLER, TX 75703
Smith County (732) 757-9377
JANAKI KHOT
Dentist (Orthodontics and Dentofacial Orthopedics)
212 OLD GRANDE BLVD STE B224
TYLER, TX 75703
Smith County (903) 509-0505

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Professional Dental Alliance Of Tx 43004 PLLC's NPI number?

The NPI number for Professional Dental Alliance Of Tx 43004 PLLC is 1093329534. It was assigned to this organization in the NPPES registry on September 2, 2020.

Where is Professional Dental Alliance Of Tx 43004 PLLC located?

Professional Dental Alliance Of Tx 43004 PLLC is located at 212 Old Grande Blvd Ste B224, Tyler, TX 75703. The listed phone number is (903) 509-0505.

What is Professional Dental Alliance Of Tx 43004 PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Professional Dental Alliance Of Tx 43004 PLLC was last updated on September 2, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.