Healthcare Provider Details

I. General information

NPI: 1063834505
Provider Name (Legal Business Name): MICHAEL DYRIW DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7518 HIGHWAY 70 S STE B
NASHVILLE TN
37221-1847
US

IV. Provider business mailing address

7518 HIGHWAY 70 S STE B
NASHVILLE TN
37221-1847
US

V. Phone/Fax

Practice location:
  • Phone: 615-669-2780
  • Fax: 615-469-1852
Mailing address:
  • Phone: 615-669-2780
  • Fax: 615-469-1852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10704
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7176-15
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9954
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE 60730973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: