Provider Demographics
NPI:1902535511
Name:STOCKER, TYLER AMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:AMES
Last Name:STOCKER
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 1:808 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3822
Mailing Address - Country:US
Mailing Address - Phone:361-212-4689
Mailing Address - Fax:
Practice Address - Street 1:9205 EAGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-5620
Practice Address - Country:US
Practice Address - Phone:281-241-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist