Provider Demographics
NPI:1932357134
Name:LOVELACE, TYLER WARREN
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:WARREN
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:WARREN
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:13000 VISTA DEL NORTE APT 537
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8053
Mailing Address - Country:US
Mailing Address - Phone:662-816-0677
Mailing Address - Fax:210-479-4059
Practice Address - Street 1:1209 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3598
Practice Address - Country:US
Practice Address - Phone:662-816-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3462-081223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics