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General NPI Number Information
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NPI Number | 1811483696
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Entity Type | Organization
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Legal Business Name | PINEY WOODS ENDODONTICS PLLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 7925 S BROADWAY AVE STE 1130
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City | TYLER
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State | TX
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Zip | 75703-5227
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Country | US
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Telephone | 713-851-7936
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Fax |
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Provider Business Mailing Address
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Address Line | 467 WOODMARK DR
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City | LONGVIEW
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State | TX
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Zip | 75605-6883
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ENDODONTIST
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Name | DR. BRYAN ALLGEIER
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Credential | DDS, MS
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Telephone | 713-851-7936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 31114
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License Number State | TX
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