Provider Demographics
NPI:1013463009
Name:TEBAY, TYLER (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TEBAY
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 1:718 W YELM AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8764
Mailing Address - Country:US
Mailing Address - Phone:360-458-5606
Mailing Address - Fax:
Practice Address - Street 1:718 W YELM AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8764
Practice Address - Country:US
Practice Address - Phone:360-458-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA606744241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice