MEDICARE: TYLER RADKEY DDS PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1043864655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER RADKEY DDS PLLC

Provider Business Mailing Address
First Line	:	3300 W MCGRAW ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-283-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 W MCGRAW ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-283-2400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYLER GREGORY RADKEY
Credential	:	DDS
Telephone Number	:	206-650-5739

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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