Provider Demographics
NPI:1326916859
Name:TYLER M. DAVIS DDS PA
Entity type:Organization
Organization Name:TYLER M. DAVIS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-618-4858
Mailing Address - Street 1:814 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2808
Mailing Address - Country:US
Mailing Address - Phone:919-556-3780
Mailing Address - Fax:919-910-5532
Practice Address - Street 1:301 KEISLER DR STE E
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7018
Practice Address - Country:US
Practice Address - Phone:919-714-2928
Practice Address - Fax:919-910-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies