Healthcare Provider Details

I. General information

NPI: 1457464596
Provider Name (Legal Business Name): TYGER RIVER FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S SPARTANBURG HWY
LYMAN SC
29365
US

IV. Provider business mailing address

350 S SPARTANBURG HWY
LYMAN SC
29365
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-0023
  • Fax: 864-439-9112
Mailing address:
  • Phone: 864-439-0023
  • Fax: 864-439-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberBA6498697
License Number StateSC

VIII. Authorized Official

Name: DR. DAVID E YODER
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 864-439-0023