Organization Name: | TYLER INGERSOLL DMD PC |
NPI Number: | 1013362276 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TYLER JAMES INGERSOLL (PRESIDENT) |
Mailing Address: | 1160 W Ash St Windsor |
State: | CO US |
Postal Code: | 805504666 |
Phone Number: | 9706861186 |
Fax Number: | 9706861248 |
NPI Enumeration Date: | 04/25/2016 |
NPI Last Update Date: | 04/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 201837 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |