Organization
TYLER NELSON, DDS, CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER NELSON DDS (OWNER)
(719) 722-0540
Entity
Organization
Contact information
Practice address
950 BOARDWALK STE 100, SAN MARCOS, CA 92078-2600
(760) 644-5494
Mailing address
950 BOARDWALK STE 100, SAN MARCOS, CA 92078-2600
(760) 644-5494
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790093599
GUARDIAN, DELTA DENTAL, UNITED CONCORDIA
—
Enumeration date
08/13/2020
Last updated
07/08/2022
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