Provider Demographics
NPI:1700400231
Name:MYERS, TYLER REED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:REED
Last Name:MYERS
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 1:120B BETTIS ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3107
Mailing Address - Country:US
Mailing Address - Phone:803-392-7082
Mailing Address - Fax:
Practice Address - Street 1:120B BETTIS ACADEMY RD
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-3107
Practice Address - Country:US
Practice Address - Phone:803-392-7082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100821223G0001X
WV44541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice