Provider Demographics
NPI:1588740187
Name:TYSON HARRELL DDS PC
Entity type:Organization
Organization Name:TYSON HARRELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-937-1671
Mailing Address - Street 1:1628 CRABB RIVER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:281-937-1671
Mailing Address - Fax:281-545-2572
Practice Address - Street 1:1628 CRABB RIVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:281-937-1671
Practice Address - Fax:281-545-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19758122300000X
TX20157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty