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EAST TEXAS DENTAL GROUP, LLC
NPI 1750743167
Dentist in Tyler, TX

Active since March 24, 2016
212 OLD GRANDE BLVD, B224, TYLER, TX 75703(903) 509-0505(903) 509-0506 Get Directions Write a Review

NPPES record last updated: March 24, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About East Texas Dental Group, Llc NPPES

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

EAST TEXAS DENTAL GROUP, LLC (NPI 1750743167) is a healthcare organization registered as a dentist in Tyler, Texas and active in the NPI registry since March 2016. The organization lists Young T Shim, Owner, as its authorized official.

NPPES Registry Identity

NPI1750743167
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameEAST TEXAS DENTAL GROUP, LLC
Location Address212 OLD GRANDE BLVD, B224Tyler, TX 75703-4226
Mailing Address212 Old Grande Blvd, Suite B224Tyler, TX 75703-4226 · (903) 509-0505 · Fax (903) 509-0506
Phone(903) 509-0505
Fax(903) 509-0506
Organization SubpartNo
Authorized OfficialYoung T ShimOwner · (903) 509-0505
Enumeration DateMarch 24, 2016
✔ NPI 1750743167 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in TX · 31033
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
212 OLD GRANDE BLVD, Tyler, TX 75703
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Other Identifiers 1

Medicaid352003301TX

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

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

EAST TEXAS DENTAL ASSOCIATES, P.A.
Dentist
212 OLD GRANDE BLVD, SUITE 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 East Texas Dental Group, LLC's NPI number?

The NPI number for East Texas Dental Group, LLC is 1750743167. It was assigned to this organization in the NPPES registry on March 24, 2016.

Where is East Texas Dental Group, LLC located?

East Texas Dental Group, LLC is located at 212 Old Grande Blvd B224, Tyler, TX 75703. The listed phone number is (903) 509-0505.

What is East Texas Dental Group, LLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for East Texas Dental Group, LLC was last updated on March 24, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.