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General NPI Number Information
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NPI Number | 1336982438
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Entity Type | Individual
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Provider Name | TYLER BOUTTE
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Gender | Male
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2423 SCHILLINGER RD S STE 104
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City | MOBILE
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State | AL
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Zip | 36695-4142
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Country | US
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Telephone | 251-634-2345
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Fax |
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Provider Business Mailing Address
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Address Line | 99 KNEELAND ST APT 306
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City | BOSTON
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State | MA
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Zip | 02111-2432
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Country | US
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Telephone | 337-579-8282
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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 | D.007547-C1
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License Number State | AL
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