Provider Demographics
NPI:1548907561
Name:MCELROY, TYLER ROSS (DMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ROSS
Last Name:MCELROY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7066 SITIO CORAZON
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2038
Mailing Address - Country:US
Mailing Address - Phone:760-331-3837
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT STE 201
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2480
Practice Address - Country:US
Practice Address - Phone:760-479-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1074331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice