Individual
DR. TYLER ROBERTO MESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
189 GREENBRIER BLVD STE A, COVINGTON, LA 70433-7297
(985) 892-5942
Mailing address
1829 LAKESHORE DR, MANDEVILLE, LA 70448-5917
(985) 705-8144
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6855
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2018
Last updated
06/16/2020
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