Provider Demographics
NPI:1255570958
Name:TYLER, ERIC ROYALL (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROYALL
Last Name:TYLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 SAN MARIN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1218
Mailing Address - Country:US
Mailing Address - Phone:415-897-6877
Mailing Address - Fax:415-897-5437
Practice Address - Street 1:190 SAN MARIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1218
Practice Address - Country:US
Practice Address - Phone:415-897-6877
Practice Address - Fax:415-897-5437
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice