Provider Demographics
NPI:1043864655
Name:TYLER RADKEY DDS PLLC
Entity Type:Organization
Organization Name:TYLER RADKEY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RADKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-650-5739
Mailing Address - Street 1:3300 W MCGRAW ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3246
Mailing Address - Country:US
Mailing Address - Phone:206-283-2400
Mailing Address - Fax:
Practice Address - Street 1:3300 W MCGRAW ST STE 240
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3246
Practice Address - Country:US
Practice Address - Phone:206-283-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental