Dr. Matt Tyson, DDS, PC

Primary specialty

DentistTaxonomy code 122300000X

License

24696 Issued in TX

Legal business name

DR. MATT TYSON, DDS, PC

Doing business as

Tyson Family Dental

Practice address

8113 Camp Bowie West Blvd
Benbrook, TX 76116-6314

Phone

(817) 560-9300

Fax

(817) 560-9303

NPI assigned

Jun 29, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matt A Tyson, D.D.D

Title

President

Phone

(214) 675-9116

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tyson Family Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467158400000",
    "number": "1396196481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8113 CAMP BOWIE WEST BLVD",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761166314",
            "telephone_number": "817-560-9300",
            "fax_number": "817-560-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8113 CAMP BOWIE WEST BLVD",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761166314",
            "telephone_number": "817-560-9300",
            "fax_number": "817-560-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. MATT TYSON, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-29",
        "last_updated": "2016-06-29",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "214-675-9116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "24696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578799250",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tyson Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Benbrook, TX
• Providers in Benbrook, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.