Provider Demographics
NPI:1407134919
Name:TYLER, CYNTHIA REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:REBECCA
Last Name:TYLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26504 NE VALLEY STREET
Mailing Address - Street 2:PO BOX 1180
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019
Mailing Address - Country:US
Mailing Address - Phone:206-930-8789
Mailing Address - Fax:
Practice Address - Street 1:26504 NE VALLEY STREET
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019
Practice Address - Country:US
Practice Address - Phone:206-930-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60566900122300000X
MT24721223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health