Individual
AUSTIN TYLER EDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
510 E LISA DR, CHAPARRAL, NM 88081-7809
(575) 824-0128
(575) 824-0179
Mailing address
115 N BEECH ST, CORTEZ, CO 81321-3207
(970) 565-7275
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00205514
CO
122300000X
Dentist
DD5457
NM
Other
Enumeration date
04/03/2021
Last updated
11/16/2023
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