Individual
TYLER DELAURENTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 W 5TH ST APT 6D, BOSTON, MA 02127-3351
(203) 909-1892
Mailing address
20 W 5TH ST APT 6D, BOSTON, MA 02127-3351
(203) 909-1892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN10000308
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2023
Last updated
11/12/2024
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