Provider Demographics
NPI:1952759474
Name:PORCO, TYLER (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:PORCO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-2011
Mailing Address - Country:US
Mailing Address - Phone:814-776-1293
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-2011
Practice Address - Country:US
Practice Address - Phone:814-776-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0408001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice