Provider Demographics
NPI:1376656785
Name:TYNES, EUGENE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:A
Last Name:TYNES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARK DR S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-1819
Mailing Address - Country:US
Mailing Address - Phone:406-761-3800
Mailing Address - Fax:406-761-3821
Practice Address - Street 1:300 PARK DR S
Practice Address - Street 2:SUITE 202
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1819
Practice Address - Country:US
Practice Address - Phone:406-761-3800
Practice Address - Fax:406-761-3821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice