Provider Demographics
NPI:1932760790
Name:PHELAN, TYLER L (DDS)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:L
Last Name:PHELAN
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 1:193 HAYDEN ROWE STREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748
Mailing Address - Country:US
Mailing Address - Phone:401-330-7677
Mailing Address - Fax:508-761-7279
Practice Address - Street 1:3 HOWARTH AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703
Practice Address - Country:US
Practice Address - Phone:508-761-5320
Practice Address - Fax:508-761-7279
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18583651223G0001X
MADN1858631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice