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General NPI Number Information
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NPI Number | 1760838288
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Entity Type | Individual
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Provider Name | JOSHUA B TYSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 1013 UNIVERSITY BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-3900
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Country | US
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Telephone | 757-956-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SHARPE DR
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City | SUFFOLK
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State | VA
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Zip | 23435-4230
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Country | US
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Telephone | 908-623-0872
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02659200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401417363
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License Number State | VA
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