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Individual

TYLER HANIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1058 FAIR ST STE A, PRESCOTT, AZ 86305-1803
(928) 776-0606
Mailing address
3290 WILLOW BUTTE CIR, PRESCOTT, AZ 86301-8540

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13989712-9923
UT

Other

Enumeration date
06/04/2024
Last updated
09/17/2025
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Product
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