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General NPI Number Information
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NPI Number | 1043838030
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Entity Type | Individual
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Provider Name | TYLER JAY PHELPS DMD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1501 N ARIZONA BLVD
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City | COOLIDGE
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State | AZ
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Zip | 85128-3215
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Country | US
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Telephone | 520-723-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 848 E DUST DEVIL CIR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-6142
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Country | US
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Telephone | 480-578-0380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | PD0018
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License Number State | AZ
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