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NPI Code Detail

MEDICARE: DR. TYSON WAYNE TINSLEY D.M.D.

MEDICARE: DR. TYSON WAYNE TINSLEY D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1083748875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYSON WAYNE TINSLEY D.M.D.
Provider Business Mailing Address
First Line : 4214 LINCOLNSHIRE DR
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2156
Country : US
Telephone Number : 618-244-6912
Fax Number : 618-244-7540
Provider Business Practice Location Address
First Line : 4214 LINCOLNSHIRE DR
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2156
Country : US
Telephone Number : 618-244-6912
Fax Number : 618-244-7540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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