Provider Demographics
NPI:1063834505
Name:DYRIW, MICHAEL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DYRIW
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 HIGHWAY 70 S STE B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1847
Mailing Address - Country:US
Mailing Address - Phone:615-669-2780
Mailing Address - Fax:615-469-1852
Practice Address - Street 1:7518 HIGHWAY 70 S STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1847
Practice Address - Country:US
Practice Address - Phone:615-669-2780
Practice Address - Fax:615-469-1852
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107041223E0200X
WI7176-15122300000X
NC99541223E0200X
WADE 607309731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist