Provider Demographics
NPI:1376995456
Name:BRANDON TYLER DDS PLLC
Entity Type:Organization
Organization Name:BRANDON TYLER DDS PLLC
Other - Org Name:DUVALL DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-788-2626
Mailing Address - Street 1:14703 1ST LN NE STE 203
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8470
Mailing Address - Country:US
Mailing Address - Phone:425-788-2626
Mailing Address - Fax:
Practice Address - Street 1:14703 1ST LN NE STE 203
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8470
Practice Address - Country:US
Practice Address - Phone:425-788-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60488503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty