Provider Demographics
NPI:1346490802
Name:PRITCHARD, TYLER SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:PRITCHARD
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 1:3700 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2228
Mailing Address - Country:US
Mailing Address - Phone:360-695-1578
Mailing Address - Fax:360-695-2878
Practice Address - Street 1:3700 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2228
Practice Address - Country:US
Practice Address - Phone:360-695-1578
Practice Address - Fax:360-695-2878
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547261223G0001X
WA601132241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60113224OtherWA STATE LICENSE
CA54726OtherSTATE LICENSE