Provider Demographics
NPI:1235383019
Name:GENERAL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GENERAL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYRER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-882-0094
Mailing Address - Street 1:108 W POINT ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-1686
Mailing Address - Country:US
Mailing Address - Phone:334-863-4514
Mailing Address - Fax:334-863-4470
Practice Address - Street 1:108 W POINT ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-1686
Practice Address - Country:US
Practice Address - Phone:334-863-4514
Practice Address - Fax:334-863-4470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COSMETIC AND RESTORATIVE GENERAL DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5533261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental