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NPI Code Detail

MEDICARE: DR. TYLER MERRILL NELSON DDS

MEDICARE: DR. TYLER MERRILL NELSON 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
1122300000XDentist8932591-9922UT
21223G0001XGeneral Practice DentistryD11734OR

General Provider Information

NPI Number : 1801381892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER MERRILL NELSON DDS
Provider Business Mailing Address
First Line : 295 S 10TH ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4623
Country : US
Telephone Number : 541-269-5353
Fax Number : 541-266-0933
Provider Business Practice Location Address
First Line : 295 S 10TH ST
Second Line :
City : COOS BAY
State : OR
Zip : 97420-4623
Country : US
Telephone Number : 541-269-5353
Fax Number : 541-266-0933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2018
Last Update Date : 02/23/2024

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