Healthcare Provider Details

I. General information

NPI: 1508432410
Provider Name (Legal Business Name): TYLER RAYBURN SERRES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # D7-19
GAINESVILLE FL
32610-0444
US

IV. Provider business mailing address

1600 SW ARCHER RD # D7-19
GAINESVILLE FL
32610-0444
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5700
  • Fax: 352-846-2891
Mailing address:
  • Phone: 352-273-5700
  • Fax: 352-846-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDRPM2319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: