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NPI Code Detail

MEDICARE: DR. TYLER CHANCELLOR DDS

MEDICARE: DR. TYLER CHANCELLOR DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry00204788CO

General Provider Information

NPI Number : 1396314365
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER CHANCELLOR DDS
Provider Business Mailing Address
First Line : 716 WILLIAMSBURG BLVD
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-5538
Country : US
Telephone Number : 303-915-4694
Fax Number :
Provider Business Practice Location Address
First Line : 4016 LEMAY FERRY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-1858
Country : US
Telephone Number : 303-305-4062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2021
Last Update Date : 08/10/2024

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Directions to “ DR. TYLER CHANCELLOR DDS” Practice Location

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