Tyler Tilden Boynton, D.M.D.
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Sonoma, CA
NPI 1992934475 · NPPES record last updated Jun 12, 2014
Key facts
- NPI
- 1992934475
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 63259 (CA)
- Practice address
- 378 Perkins St
Sonoma, CA 95476-6827 - Phone
- (707) 996-4519
- NPI assigned
- Jul 6, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 7, 2015 through Apr 7, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63259 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 63259 | CA | Yes |
Addresses
Primary practice location
378 Perkins St
Sonoma, CA 95476-6827
Mailing address
378 Perkins St
Sonoma, CA 95476-6827
Phone (707) 996-4519
Other providers in Sonoma, CA
- Jennifer Berenice Bolanos
- Heidi Crystal Bonfigli
- Roberta Ann Bostian
- John Gifford Boyce-Smith
- Wendy M Boyer
- Bradd S. Yoshioka, a Dental Corporation
- E Peabody Bradford
- Marcy Swiatek Brandner
- Sara Brashear
- Steven Brewer
All providers in Sonoma, CA · Oral and Maxillofacial Surgery (Dentist) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.