Tyler R Mesa Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

TYLER R MESA PEDIATRIC DENTISTRY

Doing business as

Live Oak Pediatric Dentistry

Practice address

2800 Gause Blvd E Ste D
Slidell, LA 70461-4247

Phone

(985) 259-6737

NPI assigned

Oct 26, 2022

Last updated

Oct 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler Mesa, DDSNPI 1134625114

Title

Owner/Pediatric Dentist

Phone

(985) 705-8144

Specialties & licenses 1

Addresses

Other names 1

• Live Oak Pediatric Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tyler Roberto Mesa, DDS

  • Pediatric Dentistry
  • Covington, LA
  • NPI 1134625114
  NPD Authorized official

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

{
    "created_epoch": "1666742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1780301036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 GAUSE BLVD E STE D",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704614247",
            "telephone_number": "985-259-6737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 GAUSE BLVD E STE D",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704614247",
            "telephone_number": "985-259-6737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER R MESA PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-26",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "MESA",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "OWNER/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "985-705-8144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Oak Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Khyra Alis Turner, LPN
• Nichole Turner, FNP-BC
• Teiraney A Turner
• Daniel P Tveit, MD
• Deborah Tveit, PMHNP-BC
• Danielle Chesser Tyler, LCSW-BACS, LCASA
• Natascha Nicole Tyler, PMHNP-BC
• Katherine Brewer Tyree, PT, DPT
• Ashlyn Elizabeth Ulmer, M.S., CCC-SLP
• Breanna Underwood

• Pediatric Dentistry in Slidell, LA
• Providers in Slidell, LA by specialty
• Pediatric Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.