Provider Demographics
NPI:1164748893
Name:PRENTICE, TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:PRENTICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6722
Mailing Address - Country:US
Mailing Address - Phone:423-855-4201
Mailing Address - Fax:423-855-4203
Practice Address - Street 1:7003 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6722
Practice Address - Country:US
Practice Address - Phone:423-855-4201
Practice Address - Fax:423-855-4203
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics