Provider Demographics
NPI:1609555804
Name:OAKES, TYLER AVERY (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:AVERY
Last Name:OAKES
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 1:601 APPLETON CT
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2286
Mailing Address - Country:US
Mailing Address - Phone:484-889-6032
Mailing Address - Fax:
Practice Address - Street 1:700 MCHUGH BLVD
Practice Address - Street 2:BLDG HP 102
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-450-4740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1346146-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist