John T Tyson | Stuart, FL • PECOS Search

John T Tyson

Dentist

Dental Providers

2614 SE Willoughby Blvd, Stuart, FL 34994-4700

(772) 283-8555 (561) 746-7702

PECOS Enrollment

Based on the most recent information from CMS, provider John T Tyson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1487699534
Provider Type
Individual
Full Name
Tyson, John T
Title
Dr.
Credential
DMD

Gender
Male
Sole Proprietor
Yes
Enumeration Date
6/20/2006
Last Updated
10/24/2008

Contact Information

Practice Location

2614 SE Willoughby Blvd, Stuart, FL 34994-4700

Unlisted Fax

Mailing Location

19874 Wilkinson Leas Rd, Tequesta, FL 33469-2178

(561) 746-6355

Provider Taxonomies

Code	Description	License
Code 122300000X Primary	Description Dentist Dental Providers	License DN9494 Florida