Provider Demographics
NPI:1558625335
Name:DEVAUGHAN, TYLER CHANCE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CHANCE
Last Name:DEVAUGHAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MONTE VISTA ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4670
Mailing Address - Country:US
Mailing Address - Phone:580-967-1817
Mailing Address - Fax:580-967-0818
Practice Address - Street 1:500 N MONTE VISTA ST STE 1B
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4670
Practice Address - Country:US
Practice Address - Phone:580-276-1834
Practice Address - Fax:580-559-0658
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6385122300000X
OK02241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist