Thomas L Tyree Dds Inc | |
1702 Oak St Kenova WV 25530-1120 | |
(304) 453-6765 | |
(304) 453-1695 |
Full Name | Thomas L Tyree Dds Inc |
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Speciality | Dentist - General Practice |
Location | 1702 Oak St, Kenova, West Virginia |
Authorized Official Name and Position | Thomas L Tyree (PRESIDENT) |
Authorized Official Contact | 3044536765 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Thomas L Tyree Dds Inc 1702 Oak St Kenova WV 25530-1120 Ph: (304) 453-6765 | Thomas L Tyree Dds Inc 1702 Oak St Kenova WV 25530-1120 Ph: (304) 453-6765 |
NPI Number | 1376612887 |
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Provider Enumeration Date | 11/07/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376612887 | NPI | - | NPPES |
0136238000 | Medicaid | WV | |
0135603 | Other | WV | DENTAL PROVIDER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 2421 (West Virginia) | Primary |