Healthcare Provider Details

I. General information

NPI: 1326916859
Provider Name (Legal Business Name): TYLER M. DAVIS DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KEISLER DR STE E
CARY NC
27518-7018
US

IV. Provider business mailing address

814 S MAIN ST
WAKE FOREST NC
27587-2808
US

V. Phone/Fax

Practice location:
  • Phone: 919-714-2928
  • Fax: 919-910-5532
Mailing address:
  • Phone: 919-556-3780
  • Fax: 919-910-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TANYA MARIE FUSSELL
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 919-618-4858