Tyler Gimenez

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11992 Issued in OR

Practice address

1025 Vey Way
The Dalles, OR 97058-1066

Phone

(541) 370-7120

NPI assigned

Apr 18, 2017

Last updated

Jul 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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 OR

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": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720828800000",
    "number": "1023542800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 VEY WAY",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970581066",
            "telephone_number": "541-370-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 VEY WAY",
            "city": "THE DALLES",
            "state": "OR",
            "postal_code": "970581066",
            "telephone_number": "541-370-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIMENEZ",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2024-07-13",
        "certification_date": "2024-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talia Garbera
• Mary Allison Gardner
• Jonathan Garner, QMHP-R
• April Gatch
• Joyce Daodao Gavino, RPT
• Gary A Gingrich, M.D.
• Richard Allen Gingrich, MD
• Shawn Girdham, PTA
• Franklin S Glover
• Lucia Gonzales, LPC

• General Practice Dentistry in The Dalles, OR
• Providers in The Dalles, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2024; 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.