Provider Demographics
NPI:1891015343
Name:TYSON, CHASE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:B
Last Name:TYSON
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 1:1410 PARAMOUNT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806
Mailing Address - Country:US
Mailing Address - Phone:256-258-9333
Mailing Address - Fax:256-242-5040
Practice Address - Street 1:1410 PARAMOUNT DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806
Practice Address - Country:US
Practice Address - Phone:256-258-9333
Practice Address - Fax:256-242-5040
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist