Kent B Boozer is a Pediatric Dentistry in Tyler, Texas. Kent B Boozer practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for Kent B Boozer is 1578502878. The last update date is 2007-07-08.
Kent B Boozer's current location address is 5540 Old Jacksonville Hwy, Tyler, Texas. You can contact this provider via phone number 9035972121 and fax number 9035817776. The mailing address for Kent B Boozer is 5540 Old Jacksonville Hwy, Tyler, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kent B Boozer |
|---|---|
| Address | 5540 Old Jacksonville Hwy, Tyler, Texas |
| Phone Number | 9035972121 |
| Fax Number | 9035817776 |
| Sole Proprietor | Y |
| Credentials | D.D.S. |
NPI Number Detail
| NPI Number | 1578502878 |
|---|---|
| Provider Enumeration Date | 2006-06-05 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 5540 Old Jacksonville Hwy |
|---|---|
| City | Tyler |
| State | Texas (TX) |
| Post Code | 757031633 |
| Phone Number | 9035972121 |
| Fax Number | 9035817776 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | 20107 |
|
Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 9556401 | TX | -- |
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What is the unique 10-digit identifier code assigned to Kent B Boozer by the Centers for Medicare & Medicaid Services?
The Kent B Boozer has been issued the NPI (National Provider Identifier) 1578502878 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you please provide the complete physical location address of Kent B Boozer?
The Kent B Boozer is physically situated at 5540 Old Jacksonville Hwy, in the city of Tyler, state of TX, with the postal code 757031633.
What is Kent B Boozer's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Kent B Boozer's specialized field of practice is Pediatric Dentistry, and the corresponding taxonomy code that categorizes this area of specialization is 1223P0221X.
When did Kent B Boozer receive its 1578502878 assignment?
The Kent B Boozer was assigned its 1578502878 on 2006-06-05, which is the date when this unique identifier was issued to the organization.
When was the information related to Kent B Boozer most recently updated or refreshed?
The details pertaining to the Kent B Boozer, including its address, specialty, and other relevant information, were last updated or refreshed on 2007-07-08.
NPI Number: 1528061710
Address: 19 Nh Route 104, Meredith, NH