Healthcare Provider Details

I. General information

NPI: 1477679371
Provider Name (Legal Business Name): TYLER,DUMAS,REYES SPECIALISTS IN ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2388 COLE ST SUITE 103
BIRMINGHAM MI
48009-7009
US

IV. Provider business mailing address

2388 COLE ST SUITE 103
BIRMINGHAM MI
48009-7009
US

V. Phone/Fax

Practice location:
  • Phone: 248-258-8283
  • Fax: 248-258-8285
Mailing address:
  • Phone: 248-258-8283
  • Fax: 248-258-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901014994
License Number StateMI

VIII. Authorized Official

Name: DR. SCOTT A. TYLER
Title or Position: PRESIDENT
Credential: D.D.S. M.S.
Phone: 248-258-8283