Provider Demographics
NPI:1366118036
Name:TYLER GOODRIDGE, DDS, PLLC
Entity type:Organization
Organization Name:TYLER GOODRIDGE, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:LANCE MATTHEW
Authorized Official - Last Name:GOODRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-670-0713
Mailing Address - Street 1:88 VILCOM CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1660
Mailing Address - Country:US
Mailing Address - Phone:919-968-9806
Mailing Address - Fax:
Practice Address - Street 1:88 VILCOM CENTER DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1660
Practice Address - Country:US
Practice Address - Phone:919-968-9806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty