Provider Demographics
NPI:1982950036
Name:TYSON DENTAL, INC
Entity type:Organization
Organization Name:TYSON DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:B
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-258-9333
Mailing Address - Street 1:1410 PARAMOUNT DR STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3010
Mailing Address - Country:US
Mailing Address - Phone:256-258-9333
Mailing Address - Fax:256-242-5040
Practice Address - Street 1:1410 PARAMOUNT DR STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3010
Practice Address - Country:US
Practice Address - Phone:256-258-9333
Practice Address - Fax:256-242-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5754261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental