Provider Demographics
NPI:1902985815
Name:TYNAN, ROBERT SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SEAN
Last Name:TYNAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1304
Mailing Address - Country:US
Mailing Address - Phone:210-534-8051
Mailing Address - Fax:210-532-2761
Practice Address - Street 1:608 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1304
Practice Address - Country:US
Practice Address - Phone:210-534-8051
Practice Address - Fax:210-532-2761
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX900-53298Medicare UPIN