Tyler Gerard Carron, DDS
Individual provider Active NPI General Practice Dentistry · Manchester, MO
NPI 1003476730 · NPPES record last updated Sep 2, 2022
Key facts
- NPI
- 1003476730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2019020686 (MO)
- Practice address
- 663 Big Bend Rd
Manchester, MO 63021-7723 - Phone
- (636) 256-3559
- Fax
- (636) 256-9879
- NPI assigned
- Jun 14, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019020686 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James H Stanford DDS PC | General Practice | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JEABDD/Endpoint/JEABDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2019020686 | MO | Yes |
Addresses
Primary practice location
663 Big Bend Rd
Manchester, MO 63021-7723
Mailing address
4 Timberstone CT
Manchester, MO 63021-7034
Phone (314) 677-8481
Other providers in Manchester, MO
- Emily Hohn Busch
- Rosemarie Ann Buza
- Kristen Ann Campbell
- David W Candy
- Care for You Home Care LLC
- Jeffrey Cavanaugh
- Cathy Chambliss
- CM Kinney and Associates, LLC
- Comfort Home Care LLC
- Contemporary Vision Center, LLC
All providers in Manchester, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.