Provider Demographics
NPI:1518416619
Name:HALES, TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:HALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2138
Mailing Address - Country:US
Mailing Address - Phone:949-429-0049
Mailing Address - Fax:
Practice Address - Street 1:777 CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2138
Practice Address - Country:US
Practice Address - Phone:949-429-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist