Provider Demographics
NPI:1447935903
Name:ASHBY, TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:ASHBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BARCO
Mailing Address - State:NC
Mailing Address - Zip Code:27917-8005
Mailing Address - Country:US
Mailing Address - Phone:801-244-6619
Mailing Address - Fax:
Practice Address - Street 1:153 WORTH GUARD RD
Practice Address - Street 2:
Practice Address - City:COINJOCK
Practice Address - State:NC
Practice Address - Zip Code:27923-9766
Practice Address - Country:US
Practice Address - Phone:252-453-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13325122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty