Provider Demographics
NPI:1083742647
Name:TYRE, THOMAS KELLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KELLY
Last Name:TYRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1607
Mailing Address - Country:US
Mailing Address - Phone:502-366-7388
Mailing Address - Fax:502-366-3086
Practice Address - Street 1:3803 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1607
Practice Address - Country:US
Practice Address - Phone:502-366-7388
Practice Address - Fax:502-366-3086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice