Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60566900 | WA |
N | 1223D0001X | Dental Public Health | 2472 | MT |
NPI | 1407134919 |
---|---|
Provider Name | Dr. Cynthia Rebecca Tyler |
First Address | Duvall, WA 98019 |
Second Address | Duvall, WA 98019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 04/02/2016 |