Provider Demographics
NPI:1073980256
Name:TYLER COLES
Entity Type:Organization
Organization Name:TYLER COLES
Other - Org Name:PREMIER SMILES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-595-7075
Mailing Address - Street 1:10000 N 31ST AVE
Mailing Address - Street 2:102 B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:602-595-7075
Mailing Address - Fax:602-606-2417
Practice Address - Street 1:10000 N 31ST AVE
Practice Address - Street 2:102 B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:602-595-7075
Practice Address - Fax:602-606-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty