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NPI Code Detail

MEDICARE: DR. TYLER J GAGNON DMD

MEDICARE: DR. TYLER J GAGNON DMD
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
11223G0001XGeneral Practice DentistryDEN4629ME

General Provider Information

NPI Number : 1548752397
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER J GAGNON DMD
Provider Business Mailing Address
First Line : 227 MOUNT AUBURN AVE
Second Line :
City : AUBURN
State : ME
Zip : 04210-8521
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 227 MOUNT AUBURN AVE
Second Line :
City : AUBURN
State : ME
Zip : 04210-8521
Country : US
Telephone Number : 207-782-3971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2018
Last Update Date : 10/19/2021

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Directions to “ DR. TYLER J GAGNON DMD” Practice Location

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