Provider Demographics
NPI:1023545951
Name:HANKS, TYLER DALE (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DALE
Last Name:HANKS
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 E 3300 S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84109
Mailing Address - Country:US
Mailing Address - Phone:801-410-0165
Mailing Address - Fax:
Practice Address - Street 1:2435 E 3300 S
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84109
Practice Address - Country:US
Practice Address - Phone:801-410-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD110341223P0221X
UT11651266-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry