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General NPI Number Information
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NPI Number | 1083264378
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Entity Type | Organization
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Legal Business Name | KIM FRETTY ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 6989 HIGHLANDS LN
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City | TYLER
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State | TX
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Zip | 75703-0639
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Country | US
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Telephone | 903-561-7873
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Fax |
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Provider Business Mailing Address
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Address Line | 6989 HIGHLANDS LN
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City | TYLER
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State | TX
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Zip | 75703-0639
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Country | US
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Telephone | 903-561-7873
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CORNEIL KIMBERLY FRETTY
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Credential |
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Telephone | 903-918-2519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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