Provider Demographics
NPI:1871724088
Name:HART, TYLER R (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:R
Last Name:HART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-1086
Mailing Address - Country:US
Mailing Address - Phone:903-587-0506
Mailing Address - Fax:903-587-0509
Practice Address - Street 1:110 W COLLIN ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2642
Practice Address - Country:US
Practice Address - Phone:903-587-0506
Practice Address - Fax:903-587-0509
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice