Provider Demographics
NPI:1386513604
Name:TYLER DAVIS DENTAL CORPORATION
Entity type:Organization
Organization Name:TYLER DAVIS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:702-480-4256
Mailing Address - Street 1:1001 AVENIDA PICO STE N
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6956
Mailing Address - Country:US
Mailing Address - Phone:949-867-3636
Mailing Address - Fax:
Practice Address - Street 1:1001 AVENIDA PICO STE N
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6956
Practice Address - Country:US
Practice Address - Phone:949-867-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty