=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447107933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TR DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2026
-----------------------------------------------------
Last Update Date | 03/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1787 WILLOW CREEK RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-888-1163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1787 WILLOW CREEK RD
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-888-1163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TYLER RICHARDS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 928-445-8980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------