Provider Demographics
NPI:1770817389
Name:TYLER, EMILY WELDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:WELDON
Last Name:TYLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6100
Mailing Address - Country:US
Mailing Address - Phone:904-217-7012
Mailing Address - Fax:904-217-7924
Practice Address - Street 1:2510 US HIGHWAY 1 S
Practice Address - Street 2:SUITE B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6100
Practice Address - Country:US
Practice Address - Phone:904-217-7012
Practice Address - Fax:904-217-7924
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist