Provider Demographics
NPI:1528576519
Name:J. TYLER CUMMINS DMD, LLC
Entity Type:Organization
Organization Name:J. TYLER CUMMINS DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-221-9190
Mailing Address - Street 1:1206 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3939
Mailing Address - Country:US
Mailing Address - Phone:205-221-9190
Mailing Address - Fax:205-384-4262
Practice Address - Street 1:1206 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3939
Practice Address - Country:US
Practice Address - Phone:205-221-9190
Practice Address - Fax:205-384-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL62801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty