Tyler Robert King, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

27.00364699 Issued in AZ

Practice address

1111 E McDowell Rd
Phoenix, AZ 85006-2612

Phone

(417) 203-0622

NPI assigned

Apr 19, 2019

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 AZ

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": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555632000000",
    "number": "1740843283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 N 12TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062837",
            "telephone_number": "417-209-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062612",
            "telephone_number": "417-203-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "TYLER",
        "middle_name": "ROBERT",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "27.00364699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sovonya King, LMT
• Susan Miller King, FNP-C
• Sydney King
• Teresa L King, NP-C
• Tyler King, MD
• Wayne King, LPC0012
• King'S Counseling Services
• King'S Heart Community Health & Wellness
• Kingdom 1St Health Amd Human Services
• Kingdom Connect Group Home, LLC

• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; 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.