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General NPI Number Information
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NPI Number | 1073287132
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Entity Type | Individual
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Provider Name | TYLER ELWOOD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 8960 W POST RD UNIT 3054
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City | LAS VEGAS
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State | NV
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Zip | 89148-2461
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Country | US
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Telephone | 801-792-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 8960 W POST RD UNIT 3054
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City | LAS VEGAS
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State | NV
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Zip | 89148-2461
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Country | US
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Telephone | 801-792-8282
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D011074
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12730935-9921
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License Number State | UT
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