Provider Demographics
NPI:1679881031
Name:DABEL, TYLER (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:DABEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4640
Mailing Address - Country:US
Mailing Address - Phone:409-962-2273
Mailing Address - Fax:409-962-0129
Practice Address - Street 1:4048 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4640
Practice Address - Country:US
Practice Address - Phone:409-962-2273
Practice Address - Fax:409-962-0129
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist