Tyler Ryan Mack, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9740 Issued in OR

Practice address

510 E 8TH St
McMinnville, OR 97128-3910

Phone

(503) 472-3147

Fax

(503) 435-1451

NPI assigned

Jul 13, 2012

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

State licenses

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1629323886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 E 8TH ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283910",
            "telephone_number": "503-472-3147",
            "fax_number": "503-435-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E 8TH ST",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971283910",
            "telephone_number": "503-472-3147",
            "fax_number": "503-435-1451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "TYLER",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Allen Lund, DPT
• Traci Rhoda Lundy
• Lutheran Community Services Northwest
• Patricia Madalena Luz, M.S. CCC-SLP
• Tami Kay Lybeck-Garner, LPC
• Richard Shane Maddox, QMHA
• Kristina Madrigal, PHARMD
• Brett Allen Maffett, M.S, LPC, NCC
• Laura Magers
• Joseph George Maier, D.C.

• General Practice Dentistry in McMinnville, OR
• Providers in McMinnville, 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, 2012; 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.