Provider Demographics
NPI:1932807856
Name:NGUYEN, TYLER LOVELLE (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:LOVELLE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 CAMP RD APT 10G
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3720
Mailing Address - Country:US
Mailing Address - Phone:803-269-3903
Mailing Address - Fax:
Practice Address - Street 1:4400 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6849
Practice Address - Country:US
Practice Address - Phone:843-790-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105931223G0001X
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice