Tyler Scott Anderson, D.D.S.
Individual provider Active NPI Prosthodontics · Denver, CO
NPI 1376922138 · NPPES record last updated Jun 3, 2025
Key facts
- NPI
- 1376922138
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- DEN.00204959 (CO)
- Practice address
- 777 Bannock St
Denver, CO 80204-4597 - Phone
- (303) 602-8200
- Fax
- (303) 602-4560
- NPI assigned
- May 27, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250228002276 | CO | Practitioner - Dentist | 5193029601 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RES3606 | OH | MD | Dentist |
| DEN.00204959 | CO | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Denver Health and Hospital Authority | Current |
Accepting new patients | |
| Denver Health and Hospital Authority | Current |
Accepting new patients |
Locations
777 Bannock St
#1923
Denver, CO 80204
Phone (303) 602-2720
777 Bannock St
Denver, CO 80204
Interoperability endpoints
- tanderson306576@direct.dhha.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | RES3606 | OH | |
| Dentist | 122300000X | DEN.00204959 | CO | |
| Prosthodontics | 1223P0700X | DEN.00204959 | CO | Yes |
Addresses
Primary practice location
777 Bannock St
Denver, CO 80204-4597
Mailing address
777 Bannock St
Denver, CO 80204-4597
Phone (303) 602-8200
Other practice location 1
3000 Arlington Ave
Mail Stop 1092
Toledo, OH 43614-2595
Phone (419) 383-3504
Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.