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NPI Code Detail

MEDICARE: DR. TYLER DALE HANKS DMD, MPH

MEDICARE:  DR. TYLER DALE HANKS  DMD, MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryD11034OR
21223P0221XPediatric Dentistry11651266-9923UT

General Provider Information

NPI Number : 1023545951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER DALE HANKS DMD, MPH
Provider Business Mailing Address
First Line : 2435 E 3300 S
Second Line : SUITE 101
City : MILLCREEK
State : UT
Zip : 84109
Country : US
Telephone Number : 801-410-0165
Fax Number :
Provider Business Practice Location Address
First Line : 2435 E 3300 S
Second Line : SUITE 101
City : MILLCREEK
State : UT
Zip : 84109
Country : US
Telephone Number : 801-410-0165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2017
Last Update Date : 10/16/2020

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