Individual
TYSON TEEPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
512 N YOUNG ST, KENNEWICK, WA 99336-7806
(509) 783-7600
Mailing address
512 N YOUNG ST, KENNEWICK, WA 99336-7806
(509) 783-7600
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9701
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DE60266972
WA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
60266972
WA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D12473
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D9701
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
366965000
—
MN
Enumeration date
06/13/2007
Last updated
11/25/2014
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