Healthcare Provider Details

I. General information

NPI: 1093673618
Provider Name (Legal Business Name): TYLER ORAL & FACIAL SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E HIGHWAY 114 STE 360
TROPHY CLUB TX
76262-5309
US

IV. Provider business mailing address

2800 E HIGHWAY 114 STE 360
TROPHY CLUB TX
76262-5309
US

V. Phone/Fax

Practice location:
  • Phone: 682-514-9026
  • Fax: 682-514-9275
Mailing address:
  • Phone: 682-514-9026
  • Fax: 682-514-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: KATIE HARRIS
Title or Position: RCM SUPERVISOR
Credential:
Phone: 903-592-1664