Healthcare Provider Details

I. General information

NPI: 1790781920
Provider Name (Legal Business Name): DONALD A TYNDALL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNC DENTAL FACULTY PRACTICE 117 BRAUER HALL, CB #7450
CHAPEL HILL NC
27599-7450
US

IV. Provider business mailing address

135 OLD LYSTRA RD
CHAPEL HILL NC
27517-6330
US

V. Phone/Fax

Practice location:
  • Phone: 919-843-4655
  • Fax: 919-966-0705
Mailing address:
  • Phone: 919-967-5476
  • Fax: 919-966-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number4820
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: