Provider Demographics
NPI:1851534226
Name:HOELZER, TYLER BRADLEY (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:BRADLEY
Last Name:HOELZER
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 1:440 STATE HIGHWAY 78
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1265
Mailing Address - Country:US
Mailing Address - Phone:972-853-2100
Mailing Address - Fax:
Practice Address - Street 1:448 36TH AVE NW STE 103
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4743
Practice Address - Country:US
Practice Address - Phone:405-321-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8404733-9922122300000X
TX25308122300000X
OK7251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist