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NPI 1033529581

NPI 1033529581 : TYLER J RICHEY DDS : TERRE HAUTE, IN

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General NPI Number Information
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    NPI Number           |    1033529581
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    Entity Type          |    Individual 
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    Provider Name        |    TYLER J RICHEY DDS
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    05/06/2014
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    Last Update Date     |    07/25/2022
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Provider Practice Location Address
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    Address Line         |    2499 E MARGARET DR 
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    City                 |    TERRE HAUTE
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    State                |    IN
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    Zip                  |    47802-3342
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    Country              |    US
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    Telephone            |    812-232-7424
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    Fax                  |    812-234-4324
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Provider Business Mailing Address
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    Address Line         |    2499 E MARGARET DR 
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    City                 |    TERRE HAUTE
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    State                |    IN
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    Zip                  |    47802-3342
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    Country              |    US
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    Telephone            |    812-232-7424
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    Fax                  |    812-234-4324
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    122300000X
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    Taxonomy Name        |    Dentist
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    License Number       |    12012114A
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    License Number State |    IN
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