Provider Demographics
NPI:1154331361
Name:TRYON, KERRY WARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:WARD
Last Name:TRYON
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 1:2412 OLD NORTH RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1548
Mailing Address - Country:US
Mailing Address - Phone:940-382-9960
Mailing Address - Fax:940-387-7014
Practice Address - Street 1:2412 OLD NORTH RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1548
Practice Address - Country:US
Practice Address - Phone:940-382-9960
Practice Address - Fax:940-387-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD155451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice