Provider Demographics
NPI:1427600717
Name:DELAET, TYLER JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JEFFREY
Last Name:DELAET
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 1:3475 N BEND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-8602
Mailing Address - Country:US
Mailing Address - Phone:513-741-8223
Mailing Address - Fax:513-741-8234
Practice Address - Street 1:3475 N BEND RD STE 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-8602
Practice Address - Country:US
Practice Address - Phone:513-741-8223
Practice Address - Fax:513-741-8234
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty