Organization
THOMAS L TYREE DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS L TYREE DDS (PRESIDENT)
(304) 453-6765
Entity
Organization
Contact information
Practice address
1702 OAK ST, KENOVA, WV 25530-1120
(304) 453-6765
(304) 453-1695
Mailing address
1702 OAK ST, KENOVA, WV 25530-1120
(304) 453-6765
(304) 453-1695
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2421
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0135603
DENTAL PROVIDER
WV
05
—
0136238000
—
WV
Enumeration date
11/07/2006
Last updated
08/22/2020
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