Provider Demographics
NPI:1376995456
Name:BRANDON TYLER DDS PLLC
Entity type:Organization
Organization Name:BRANDON TYLER DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-710-5015
Mailing Address - Street 1:26504 NE VALLEY ST
Mailing Address - Street 2:PO BOX 1180
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019
Mailing Address - Country:US
Mailing Address - Phone:360-710-5015
Mailing Address - Fax:
Practice Address - Street 1:26504 NE VALLEY ST
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019
Practice Address - Country:US
Practice Address - Phone:360-710-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty