Individual
DR. TYLER WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1601 S SECOND ST, GALLUP, NM 87301-5816
(505) 722-4422
Mailing address
1601 S SECOND ST, GALLUP, NM 87301-5816
(505) 722-4422
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4145
NM
Other
Enumeration date
11/05/2014
Last updated
11/05/2014
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