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General NPI Number Information
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NPI Number | 1932529526
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Entity Type | Individual
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Provider Name | TYLER SMITH DMD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 1737 YORK AVE 1A
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City | NEW YORK
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State | NY
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Zip | 10128-6841
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Country | US
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Telephone | 212-534-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 161 E 88TH ST APT 5D
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City | NEW YORK
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State | NY
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Zip | 10128-2245
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Country | US
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Telephone | 763-443-5212
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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 | D13588
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License Number State | MN
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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 | 058312
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License Number State | NY
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