Tyler Jensen Smith, D.D.S.
Individual provider Active NPI Dentist · Avenal, CA
NPI 1497920342 · NPPES record last updated Apr 22, 2008
Key facts
- NPI
- 1497920342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 25059 (CA)
- Practice address
- 1 Kings Way
Avenal, CA 93204-9708 - Phone
- (559) 386-0587
- NPI assigned
- Apr 22, 2008
- 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 |
|---|---|---|---|
| 25059 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corrections and Rehabilitation-Headquarters | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25059 | CA | Yes |
Addresses
Primary practice location
1 Kings Way
Avenal, CA 93204-9708
Mailing address
1 Kings Way
Avenal, CA 93204-9708
Phone (559) 386-0587
Other providers in Avenal, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2008. 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.