Provider Demographics
NPI:1710136049
Name:SHINER, TYLER (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SHINER
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 1:1169 W HIGHWAY 40 STE C
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2911
Mailing Address - Country:US
Mailing Address - Phone:435-781-0660
Mailing Address - Fax:
Practice Address - Street 1:1169 W HIGHWAY 40 STE C
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2911
Practice Address - Country:US
Practice Address - Phone:435-781-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT671235799231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice