Times Square Family Dental PA

NPI #1174954424 in Tyler, Texas

Provider Information

NPI Number: 1174954424
Entity Type: Organization
Organization Name: Times Square Family Dental PA
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 11, 2013
Last Updated: Dec 11, 2013

Practice Location

Address: 5201 S BROADWAY AVE
Address 2: SUITE 240
City: Tyler
State: Texas
ZIP Code: 75703-3748
Phone: (903) 534-8110

Authorized Official

Name: DR. KAIVAN KEVIN AFKHAMI, DDS
Title: PRESIDENT
Phone: (817) 577-9200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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