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General NPI Number Information
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NPI Number | 1881172062
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Entity Type | Individual
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Provider Name | TYLER MICHAEL SANDERS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 3735 LONGLEAF PINE PKWY # 223-224
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City | ST JOHNS
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State | FL
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Zip | 32259-7482
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Country | US
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Telephone | 904-769-5848
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Fax |
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Provider Business Mailing Address
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Address Line | 6965 EL CAMINO REAL # 105-645
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City | CARLSBAD
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State | CA
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Zip | 92009-4100
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Country | US
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Telephone | 719-289-4777
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS102821
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License Number State | CA
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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 | DN27206
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License Number State | FL
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