Provider Demographics
NPI:1104062843
Name:EUGENE A. TYNES D.D.S. P.C.
Entity type:Organization
Organization Name:EUGENE A. TYNES D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-761-3800
Mailing Address - Street 1:300 PARK DR S STE 202
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-1819
Mailing Address - Country:US
Mailing Address - Phone:406-761-3800
Mailing Address - Fax:
Practice Address - Street 1:300 PARK DR S STE 202
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1819
Practice Address - Country:US
Practice Address - Phone:406-761-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT810493586OtherDENTIST