Provider Demographics
NPI:1013909985
Name:TYLER, KENNETH DALE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DALE
Last Name:TYLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14123
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4123
Mailing Address - Country:US
Mailing Address - Phone:480-860-1474
Mailing Address - Fax:
Practice Address - Street 1:9097 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6277
Practice Address - Country:US
Practice Address - Phone:480-860-1474
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
AZ44561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics