Healthcare Provider Details

I. General information

NPI: 1861311516
Provider Name (Legal Business Name): DYNAMIC WELLNESS CONNECTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CANTON AVE
MILTON MA
02186-3134
US

IV. Provider business mailing address

720 CANTON AVE
MILTON MA
02186-3134
US

V. Phone/Fax

Practice location:
  • Phone: 617-901-2201
  • Fax:
Mailing address:
  • Phone: 617-901-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS TYRELL
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D
Phone: 617-901-2201