Healthcare Provider Details

I. General information

NPI: 1457553596
Provider Name (Legal Business Name): JIMMY GLYNN TOMPKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S HORACE AVE
TYLER TX
75702-6159
US

IV. Provider business mailing address

PO BOX 2039
TYLER TX
75710-2039
US

V. Phone/Fax

Practice location:
  • Phone: 903-526-4900
  • Fax: 903-526-4907
Mailing address:
  • Phone: 903-535-0023
  • Fax: 903-535-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8861
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: