MEDICARE: HUNTSVILLE FAMILY DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1891359725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTSVILLE FAMILY DENTAL

Provider Business Mailing Address
First Line	:	4324 LAZY CREEK DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75707-1554
Country	:	US
Telephone Number	:	972-248-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 COLLARD RD
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-6418
Country	:	US
Telephone Number	:	936-295-5437
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM ROBERT JENNINGS JR.
Credential	:	DDS
Telephone Number	:	940-206-8956

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	06/26/2026

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