Provider Demographics
NPI:1578799250
Name:TYSON, MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:TYSON
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 1:3323 UNICORN LAKE BLVD.
Mailing Address - Street 2:SUITE 131
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-382-3834
Mailing Address - Fax:
Practice Address - Street 1:3323 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 131
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0122
Practice Address - Country:US
Practice Address - Phone:940-382-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist