MEDICARE: TYLER DENTAL, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1265830020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER DENTAL, PLLC

Provider Business Mailing Address
First Line	:	12185 NEW WORLD DR
Second Line	:	SUITE 201
City	:	EL PASO
State	:	TX
Zip	:	79936-6396
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12185 NEW WORLD DR
Second Line	:	SUITE 201
City	:	EL PASO
State	:	TX
Zip	:	79936-6396
Country	:	US
Telephone Number	:	972-362-2225
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAMIM MOSLEMI
Credential	:
Telephone Number	:	972-362-2225

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	11/30/2015

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