Provider Demographics
NPI:1457557399
Name:TYROS, KATHERINE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:R
Last Name:TYROS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2718
Mailing Address - Country:US
Mailing Address - Phone:978-256-2561
Mailing Address - Fax:978-256-5529
Practice Address - Street 1:18 NORTH RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2718
Practice Address - Country:US
Practice Address - Phone:978-256-2561
Practice Address - Fax:978-256-5529
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19463OtherLICENSE NUMBER