Provider Demographics
NPI:1760687693
Name:TYRER, JAMES A III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:TYRER
Suffix:III
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 1:407 N GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2201
Mailing Address - Country:US
Mailing Address - Phone:706-882-0094
Mailing Address - Fax:706-882-7373
Practice Address - Street 1:407 N GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2201
Practice Address - Country:US
Practice Address - Phone:706-882-0094
Practice Address - Fax:706-882-7373
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA122101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice