Provider Demographics
NPI:1497371926
Name:LARKIN, TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:LARKIN
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 1:1258 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2418
Mailing Address - Country:US
Mailing Address - Phone:917-843-2632
Mailing Address - Fax:
Practice Address - Street 1:530 E HUNT HWY STE 123
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6583
Practice Address - Country:US
Practice Address - Phone:480-987-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0107171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice