Healthcare Provider Details

I. General information

NPI: 1508798869
Provider Name (Legal Business Name): TYLER SCOTT ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 9TH ST STE 190
DES MOINES IA
50314-2527
US

IV. Provider business mailing address

13286 NE 56TH ST
ELKHART IA
50073-9018
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-9136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10466
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: