# DR. MATT TYSON, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tyson Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396196481
- **Authorized official:** DR. MATT A TYSON D.D.D (PRESIDENT)
- **Authorized official phone:** (214) 675-9116

## Contact information

- **Practice address:** 8113 CAMP BOWIE WEST BLVD, BENBROOK, TX 76116-6314
- **Practice address phone:** (817) 560-9300
- **Practice address fax:** (817) 560-9303
- **Mailing address:** 8113 CAMP BOWIE WEST BLVD, BENBROOK, TX 76116-6314
- **Mailing address phone:** (817) 560-9300
- **Mailing address fax:** (817) 560-9303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 24696 | TX | Yes |

## Other

- **Enumeration date:** 06/29/2016
- **Last updated:** 06/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1578799250 | — | TX |