Provider Demographics
NPI:1811144843
Name:WINTERS, TYLER CHRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CHRIS
Last Name:WINTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 AIRLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-9603
Mailing Address - Country:US
Mailing Address - Phone:405-238-2222
Mailing Address - Fax:405-238-5181
Practice Address - Street 1:1600 AIRLINE ROAD
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-9603
Practice Address - Country:US
Practice Address - Phone:405-238-2222
Practice Address - Fax:405-238-5181
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist