Provider Demographics
NPI:1457605370
Name:DYER, TEDDY PAUL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TEDDY
Middle Name:PAUL
Last Name:DYER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:841 N TARRANT PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-6860
Mailing Address - Country:US
Mailing Address - Phone:817-281-0100
Mailing Address - Fax:817-281-0111
Practice Address - Street 1:841 N TARRANT PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-6860
Practice Address - Country:US
Practice Address - Phone:817-281-0100
Practice Address - Fax:817-281-0111
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX280641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice