NPIMap

Individual provider Active NPI

Tyler Dale Hanks, DMD, MPH

  • Pediatric Dentistry
  • Millcreek, UT
National Provider Identifier
1023545951
Registry record updated Oct 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
11651266-9923 Issued in UT
Practice address
2435 E 3300 S
Suite 101
Millcreek, UT 84109
Phone
(801) 410-0165
NPI assigned
May 23, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X D11034 OR
Pediatric Dentistry 1223P0221X 11651266-9923 UT Primary

Addresses

Primary practice location

2435 E 3300 S
Suite 101
Millcreek, UT 84109

Mailing address

2435 E 3300 S
Suite 101
Millcreek, UT 84109
Phone (801) 410-0165

Other practice location 1

1291 E McAndrews Rd
Medford, OR 97504
Phone (541) 779-8923

Other practice location 2

1291 E McAndrews Rd
Medford, OR 97504
Phone (541) 779-8923

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D11034ORMDPediatric Dentist
11651266-9923UTMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Happy Tooth Pediatric Dentistry, LLC Pediatric Dentistry Current Accepting new patients
David M Alex DDS PC Pediatric Dentistry Past Accepting new patients
James Kolby Robinson, DMD Pediatric Dentistry PastSince Jul 27, 2020 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1495497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1023545951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2435 E 3300 S",
            "address_2": "SUITE 101",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "84109",
            "telephone_number": "801-410-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2435 E 3300 S",
            "address_2": "SUITE 101",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "84109",
            "telephone_number": "801-410-0165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1291 E McAndrews Rd",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "97504",
            "country_code": "US",
            "telephone_number": "541-779-8923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1291 E McAndrews Rd",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "97504",
            "country_code": "US",
            "telephone_number": "541-779-8923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANKS",
        "first_name": "TYLER",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "DMD, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-23",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11034",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "11651266-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millcreek, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.