Doctor Name: | DR. CHESTER J TYSON |
NPI Number: | 1003970534 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 6504 |
Business Practice Address: | 2606 Iron Gate Dr Suite 200 Wilmington, NC - 284122573 |
Business Phone Number: | 9107917380 |
Business Fax Number: | 9107918160 |
Mailing Address: | 2606 Iron Gate Dr, Suite 200 WILMINGTON |
State: | NC |
Postal Code: | 284122573 |
Phone Number: | 9107917380 |
Fax Number: | 9107918160 |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 6504 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |