Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 63359359921 | UT |
NPI | 1063530269 |
---|---|
Provider Name | Dr. Tyler R Albrecht |
First Address | Cedar City, UT 84720-8916 |
Second Address | Cedar City, UT 84720-8916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |