Tyler Alan Fordham, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE60212723 Issued in WA

Practice address

407 N 63Rd Ave
Yakima, WA 98908-2707

Phone

(509) 823-1087

NPI assigned

Mar 18, 2011

Last updated

Mar 18, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300406400000",
    "number": "1003115841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 N 63RD AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989082707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N 63RD AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989082707",
            "telephone_number": "509-823-1087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORDHAM",
        "first_name": "TYLER",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-18",
        "last_updated": "2011-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60212723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Folsom
• Margie Fontana
• Darby Bridget Foor, ARNP, RN
• Amy Nguyen Ford, MD
• Jennifer Marie Ford, MD
• Coleen Foreman, PAC
• Janice Raye Foresyth
• Mariah Forgey
• Miranda Forgey
• Sally Jane Forrest, LMHC

• Dentist in Yakima, WA
• Providers in Yakima, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.