Healthcare Provider Details

I. General information

NPI: 1831334929
Provider Name (Legal Business Name): TYLER JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 CARLSBAD VILLAGE DR
CARLSBAD CA
92008-1950
US

IV. Provider business mailing address

1287 CARLSBAD VILLAGE DR
CARLSBAD CA
92008-1950
US

V. Phone/Fax

Practice location:
  • Phone: 619-339-0760
  • Fax:
Mailing address:
  • Phone: 619-339-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56144
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number1498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: