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General NPI Number Information
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NPI Number | 1619546413
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Entity Type | Individual
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Provider Name | TYLER ANTHONY THOMPSON DDS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 02/16/2025
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Provider Practice Location Address
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Address Line | 29001 CEDAR RD STE 428
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City | LYNDHURST
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State | OH
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Zip | 44124-4041
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Country | US
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Telephone | 404-375-9427
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Fax |
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Provider Business Mailing Address
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Address Line | 8492 RAYA LN
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City | STREETSBORO
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State | OH
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Zip | 44241-4233
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Country | US
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Telephone | 404-375-9427
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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 | 30.026556
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License Number State | OH
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