MEDICARE: DR. TYLER LYNN SCOTT DDS

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	122300000X	Dentist	30.023017	OH

General Provider Information

NPI Number	:	1174752992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER LYNN SCOTT DDS

Provider Business Mailing Address
First Line	:	633 N UNION ST
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1074
Country	:	US
Telephone Number	:	419-994-3111
Fax Number	:	419-994-4078

Provider Business Practice Location Address
First Line	:	633 N UNION ST
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1074
Country	:	US
Telephone Number	:	419-994-3111
Fax Number	:	419-994-4078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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