Tyler Chance Devaughan, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

0224 Issued in OK

Practice address

500 N Monte Vista St Ste 1B
Ada, OK 74820-4670

Phone

(580) 276-1834

Fax

(580) 559-0658

NPI assigned

Jun 27, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1558625335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N MONTE VISTA ST STE 1B",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204670",
            "telephone_number": "580-967-1817",
            "fax_number": "580-967-0818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N MONTE VISTA ST STE 1B",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204670",
            "telephone_number": "580-276-1834",
            "fax_number": "580-559-0658"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1024 SW 104th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731392990",
            "country_code": "US",
            "telephone_number": "405-730-3527",
            "fax_number": "405-703-3548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEVAUGHAN",
        "first_name": "TYLER",
        "middle_name": "CHANCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "6385",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OK",
            "license": "0224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce W Dennis, MD
• Dusty K Dennis, PT
• Kent Denson
• William L Deprater, D.D.S.
• Bailey Deramus
• Kayla Don Dewitt, DPT
• Glen Edward Diacon Jr., MD
• Shannon Nicole Dial, LMFT
• Kathryn Suzanne Dickerson, BS/BHWC
• John Phillip Dickinson, ARNP

• Orthodontics and Dentofacial Orthopedics Dentistry in Ada, OK
• Providers in Ada, OK by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.