Provider Demographics
NPI:1922307503
Name:SALLY TRYON DMD PC
Entity Type:Organization
Organization Name:SALLY TRYON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-264-1687
Mailing Address - Street 1:37 WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2619
Mailing Address - Country:US
Mailing Address - Phone:201-264-1687
Mailing Address - Fax:201-891-5368
Practice Address - Street 1:200 WHITE RD
Practice Address - Street 2:SUITE 113
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1150
Practice Address - Country:US
Practice Address - Phone:732-842-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023826001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty