Individual
TYLER ANTONELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4175 S ALAMO AVE, DAVIS-MONTHAN AFB, AZ 85707
(910) 619-6720
Mailing address
4175 S ALAMO AVE, DAVIS-MONTHAN AFB, AZ 85707
(910) 619-6720
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11977
NC
Other
Enumeration date
04/17/2020
Last updated
09/20/2021
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