Provider Demographics
NPI:1730921511
Name:BANKS, TYLER JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:BANKS
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 1:2 PINECREST LN
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6121
Mailing Address - Country:US
Mailing Address - Phone:501-680-5405
Mailing Address - Fax:
Practice Address - Street 1:2665 DONAGHEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-2318
Practice Address - Country:US
Practice Address - Phone:501-450-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR47501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice