Provider Demographics
NPI:1447743653
Name:MCCUBBINS, TYLER FIELDING (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:FIELDING
Last Name:MCCUBBINS
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 1:169 ASHLEY AVENUE ROOM 202
Mailing Address - Street 2:MAIN HOSPITAL MSC333
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-3916
Mailing Address - Fax:
Practice Address - Street 1:124 GOODVIEW WAY STE B
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4927
Practice Address - Country:US
Practice Address - Phone:615-575-3344
Practice Address - Fax:615-575-3344
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101141223G0001X
TN112791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice