Provider Demographics
NPI:1891144739
Name:RALLISON, TYLER MONTY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MONTY
Last Name:RALLISON
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 1:183 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2395
Mailing Address - Country:US
Mailing Address - Phone:801-663-6451
Mailing Address - Fax:
Practice Address - Street 1:183 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-2395
Practice Address - Country:US
Practice Address - Phone:801-825-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9832750-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist