Provider Demographics
NPI:1265464028
Name:SMITH, TYSON COURTNEY (DDS)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:COURTNEY
Last Name:SMITH
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 1:310 WENDELL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-6317
Mailing Address - Fax:406-535-2089
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-6317
Practice Address - Fax:406-535-2089
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist