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General NPI Number Information
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NPI Number | 1760974729
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Entity Type | Individual
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Provider Name | TYLER MOREHART DMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 849 DIXIE HWY
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City | ROSSFORD
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State | OH
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Zip | 43460-1375
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Country | US
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Telephone | 419-666-3327
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Fax |
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Provider Business Mailing Address
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Address Line | 849 DIXIE HWY
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City | ROSSFORD
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State | OH
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Zip | 43460-1375
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Country | US
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Telephone | 196-663-3274
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 30.025462
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License Number State | OH
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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 | 30.025462
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License Number State | OH
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