Dr. Chester J Tyson IV
Pediatric Dentist
2606 Iron Gate Dr Suite 200
Wilmington
, North Carolina 28412-2573
Dr. Chester J Tyson IV
Pediatric Dentist
2606 Iron Gate Dr Suite 200
Wilmington
, North Carolina 28412-2573
(910) 791-8160
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About
Features
Specialties
- Pediatric Dentist
Languages spoken
- English
Location
First Address
- Dr. Chester J Tyson IV
- 2606 Iron Gate Dr Suite 200
- Wilmington, NC
- Zip : 28412-2573
- Fax : (910) 791-8160
- Phone : (910) 791-7380
Second Address
- Dr. Chester J Tyson IV
- 2606 Iron Gate Dr Suite 200
- Wilmington, NC
- Zip : 28412-2573
- Fax : (910) 791-8160
- Phone : (910) 791-7380
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Is Dr. Chester J Tyson IV a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0221X | Pediatric Dentist | 6504 | NC |
National Provider Identifier
| NPI | 1003970534 |
|---|---|
| Provider Name | Dr. Chester J Tyson IV |
| First Address | Wilmington, NC 28412-2573 |
| Second Address | Wilmington, NC 28412-2573 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 20/12/2006 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 9003C | (05) | NC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.