Provider Demographics
NPI:1811251598
Name:BOSS, TYLER
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:BOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5491 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3540 W 6000 S
Practice Address - Street 2:STE. #100
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9071
Practice Address - Country:US
Practice Address - Phone:801-779-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8322701-99221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics