# THOMAS L TYREE DDS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376612887
- **Authorized official:** THOMAS L TYREE DDS (PRESIDENT)
- **Authorized official phone:** (304) 453-6765

## Contact information

- **Practice address:** 1702 OAK ST, KENOVA, WV 25530-1120
- **Practice address phone:** (304) 453-6765
- **Practice address fax:** (304) 453-1695
- **Mailing address:** 1702 OAK ST, KENOVA, WV 25530-1120
- **Mailing address phone:** (304) 453-6765
- **Mailing address fax:** (304) 453-1695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2421 | WV | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0135603 | DENTAL PROVIDER | WV |
| 05 | — | 0136238000 | — | WV |