Healthcare Provider Details

I. General information

NPI: 1174752992
Provider Name (Legal Business Name): TYLER LYNN SCOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N UNION ST
LOUDONVILLE OH
44842-1074
US

IV. Provider business mailing address

633 N UNION ST
LOUDONVILLE OH
44842-1074
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-3111
  • Fax: 419-994-4078
Mailing address:
  • Phone: 419-994-3111
  • Fax: 419-994-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: