Provider Demographics
NPI:1689479669
Name:DANTZLER, TYREE ANTHONY
Entity type:Individual
Prefix:
First Name:TYREE
Middle Name:ANTHONY
Last Name:DANTZLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 HADWICK DRIVE
Mailing Address - Street 2:APT D
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221
Mailing Address - Country:US
Mailing Address - Phone:667-450-2549
Mailing Address - Fax:
Practice Address - Street 1:1416 HADWICK DRIVE
Practice Address - Street 2:APT D
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:667-450-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician