=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376922138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYLER SCOTT ANDERSON D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 BANNOCK ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-602-8200
-----------------------------------------------------
Fax | 303-602-4560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 777 BANNOCK ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-602-8200
-----------------------------------------------------
Fax | 303-602-4560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | RES3606
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN.00204959
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DEN.00204959
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------