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General NPI Number Information
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NPI Number | 1609551779
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Entity Type | Individual
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Provider Name | TYLER BIANCA DUFORD DDS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 20311 S ELLSWORTH RD STE 101
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-2400
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Country | US
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Telephone | 480-999-4484
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Fax |
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Provider Business Mailing Address
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Address Line | 2631 E BLUE SPRUCE LN
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City | GILBERT
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State | AZ
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Zip | 85298-3422
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Country | US
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Telephone |
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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 | D011858
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011858
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License Number State | AZ
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