Active NPI
John T Tyson, DMD
- Dentist
- Stuart, FL
National Provider Identifier
1487699534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN9494
- Practice address
- 2614 SE Willoughby Blvd
Stuart, FL 34994-4700 - Phone
- (772) 283-8555
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN9494 | FL | Primary |
Addresses
Primary practice location
2614 SE Willoughby Blvd
Stuart, FL 34994-4700
Mailing address
19874 Wilkinson Leas Rd
Tequesta, FL 33469-2178
Phone (561) 746-7702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN9494 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224806400000",
"number": "1487699534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19874 WILKINSON LEAS RD",
"city": "TEQUESTA",
"state": "FL",
"postal_code": "334692178",
"telephone_number": "561-746-7702",
"fax_number": "561-746-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2614 SE WILLOUGHBY BLVD",
"city": "STUART",
"state": "FL",
"postal_code": "349944700",
"telephone_number": "772-283-8555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYSON",
"first_name": "JOHN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2008-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN9494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.