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General NPI Number Information
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NPI Number | 1871090860
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Entity Type | Organization
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Legal Business Name | DYLAN PATRICK DDS, PLLC
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 419 W SW LOOP 323 STE 300
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City | TYLER
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State | TX
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Zip | 75701-7062
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Country | US
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Telephone | 903-251-9292
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Fax | 903-207-8642
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Provider Business Mailing Address
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Address Line | 2660 BARTON CREEK CIR
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City | TYLER
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State | TX
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Zip | 75703-7054
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Country | US
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Telephone | 903-363-3648
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DYLAN PATRICK
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Credential | DDS
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Telephone | 903-363-3648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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