MEDICARE: TYLER RICHARDS

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	D012511	AZ

General Provider Information

NPI Number	:	1407679038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER RICHARDS

Provider Business Mailing Address
First Line	:	3140 STILLWATER DR STE B
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7105
Country	:	US
Telephone Number	:	801-888-1163
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 STILLWATER DR STE B
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7105
Country	:	US
Telephone Number	:	801-888-1163
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	06/01/2025

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Directions to “ TYLER RICHARDS ” Practice Location

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