MEDICARE: TYLER J. DELAET, DMD, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1881303485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER J. DELAET, DMD, LLC

Provider Business Mailing Address
First Line	:	3475 N BEND RD STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-8602
Country	:	US
Telephone Number	:	513-741-8223
Fax Number	:	513-741-8234

Provider Business Practice Location Address
First Line	:	3475 N BEND RD STE 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-8602
Country	:	US
Telephone Number	:	513-741-8223
Fax Number	:	513-741-8234

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. TYLER JEFFREY DELAET
Credential	:	DMD
Telephone Number	:	513-741-8223

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	12/30/2022

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