Provider Demographics
NPI:1053898676
Name:PARSONS, TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:PARSONS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL ACTIVITY
Mailing Address - Street 2:36000 DARNALL LOOP
Mailing Address - City:FT. HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:210-833-0093
Mailing Address - Fax:
Practice Address - Street 1:4421 IRVING BLVD NW # 87114
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4286
Practice Address - Country:US
Practice Address - Phone:505-821-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343771223G0001X
NMDD56011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice